Current Procedural Terminology 2012 American Medical Association. All Rights Reserved. Codes published herein are current on the publication/effective date and are subject to change. Sent To: CAP excluding Dentists and Pharmacies Contains Public Information New Medical Director of Medical Review Joins BCBSKS Kent Haverkamp, M.D., recently joined Blue Cross and Blue Shield of Kansas as the company’s next medical director of medical review. Dr. Haverkamp will assume responsibility for those duties when Howell Johnson, M.D., retires from that position in late March, after more than ten years of service. In his new position, Dr. Haverkamp is responsible for directing the development of medical policies, and will chair the claims review committee. He also is responsible for analyzing medical trends to identify needs for changes in medical review that support strategic objectives, providing educational sessions for medical review staff members, and is a physician resource for the department and company as a whole. Prior to joining BCBSKS, Dr. Haverkamp practiced with the Cotton-O’Neil medical group in Topeka for 20 years, and served on its medical executive committee. In addition, he was the medical director of the Countryside Health Center, also in Topeka. He earned his bachelor’s from Kansas State University and his medical degree from the University of Kansas School of Medicine in Wichita. Dr. Haverkamp completed internal medicine and pediatrics residencies in Phoenix at Good Samaritan Hospital and Phoenix Children’s Hospital. He is board certified in internal medicine and pediatrics. MARCH 20, 2013 S-2-13 WHAT’S INSIDE ? The Blue Shield Report is published by the professional relations department of Blue Cross and Blue Shield of Kansas. OUR WEB ADDRESS: http://www.bcbsks.com Ann Dunn, Communications Coordinator Questions: Contact your professional relations representative or provider network services in Topeka at 785-291-4135 or 1-800-432-3587. Acknowledgement: Current Procedural Terminology (CPT®) is copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable ARS/DFARS Restrictions Apply to Government Use. New Medical Director of Medical Review Joins BCBSKS ........................... 1 TriWest Creates Transition Web Site .... 2 THANK YOU for Serving Those Who Serve .............................................. 2 Don’t Wait . . . UPDATE! ................... 2, 3 Do you know you can contact Provider Network Services via e-mail, too? .................................... 3 Pharmaceutical Formulary Update ....... 3 National Drug Code (NDC) Format Change ........................................... 4 Web Changes – Medical Policy ......... 4, 5 BCBSKS Recognizes Six Hospitals as Blue Distinction Centers ................. 6 National Walk @Lunch Day.................. 7 Inactive Providers ................................. 7 Medical Record Review for FEP HEDIS . 8 Kent Haverkamp, M.D. Howell Johnson, M.D.
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Current Procedural Terminology 2012 American Medical Association. All Rights Reserved. Codes published herein are current on the publication/effective date and are subject to change.
Sent To: CAP excluding Dentists and Pharmacies Contains Public Information
New Medical Director of Medical Review Joins BCBSKS
Kent Haverkamp, M.D., recently joined Blue Cross and Blue Shield of Kansas as the company’s next medical director of medical review. Dr. Haverkamp will assume responsibility for those duties when Howell Johnson, M.D., retires from that position in late March, after more than ten years of service.
In his new position, Dr. Haverkamp is responsible for directing the development of medical policies, and will chair the claims review committee. He also is responsible for analyzing medical trends to identify needs for changes in medical review that support strategic objectives, providing educational sessions for medical review staff members, and is a physician resource for the department and company as a whole.
Prior to joining BCBSKS, Dr. Haverkamp practiced with the Cotton-O’Neil medical group in Topeka for 20 years, and served on its medical executive committee. In addition, he was the medical director of the Countryside Health Center, also in Topeka.
He earned his bachelor’s from Kansas State University and his medical degree from the University of Kansas School of Medicine in Wichita. Dr. Haverkamp completed internal medicine and pediatrics residencies in Phoenix at Good Samaritan Hospital and Phoenix Children’s Hospital. He is board certified in internal medicine and pediatrics.
MARCH 20, 2013 S-2-13
WHAT’S INSIDE ?
The Blue Shield Report is published by the professional relations department of Blue Cross and Blue Shield of Kansas.
OUR WEB ADDRESS: http://www.bcbsks.com
Ann Dunn, Communications Coordinator
Questions: Contact your professional relations representative or provider network services in Topeka at 785-291-4135 or 1-800-432-3587. Acknowledgement: Current Procedural Terminology (CPT®) is copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable ARS/DFARS Restrictions Apply to Government Use.
New Medical Director of Medical Review Joins BCBSKS ........................... 1
TriWest Creates Transition Web Site .... 2
THANK YOU for Serving Those Who Serve .............................................. 2
Don’t Wait . . . UPDATE! ................... 2, 3
Do you know you can contact Provider Network Services via e-mail, too? .................................... 3
Pharmaceutical Formulary Update ....... 3
National Drug Code (NDC) Format Change ........................................... 4
Web Changes – Medical Policy ......... 4, 5
BCBSKS Recognizes Six Hospitals as Blue Distinction Centers ................. 6
National Walk @Lunch Day .................. 7
Inactive Providers ................................. 7
Medical Record Review for FEP HEDIS . 8
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March 20, 2013 BLUE SHIELD REPORT S-2-13
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Contains Public Information Page 2
THANK YOU for Serving Those Who Serve
The TRICARE contract is coming to a close on March 31 this year. Blue Cross and Blue Shield of Kansas and TriWest wish to thank those dedicated providers who have devoted themselves to serving our nation’s heroes. We want to take this moment and thank you. Thank you for caring so deeply. Thank you for partnering with us to serve those who serve. Thank you for making the choice to care for the men and women who watch over our country—just as they made the choice to enter a life of service—for us. TriWest has administered the TRICARE program for the Western Region the past 16 years, and with the help of Kansas contracted providers, built a strong provider network of 190,000 providers, all working toward the shared goal of caring for our nation’s heroes. This could not have been accomplished without the dedication and support of Kansas providers! Thank you!
Don’t Wait . . . UPDATE! Why is data about you and your practice so important? 1) Your patients and other providers can locate and contact you, 2) Directories are updated in near real-time which allow changes in your
provider data to be available quickly, 3) Correspondence is delivered to you with confidence when your data
is accurate. Blue Cross and Blue Shield of Kansas has an obligation to providers and members to maintain accurate data files. Practices are busy and sometimes overlook communicating provider updates or are concerned that claims will no longer pay on a provider whose network status has been terminated. Claims filed for dates of service prior to a provider termination will continue to be processed. Don't wait for claims to pay out on those providers who have left before letting BCBSKS know a provider has left the practice. Notify us any time a provider leaves a group or location, is no longer planning to renew his/her Kansas license or moves out of the state, passes away, etc. Notifying us of these instances immediately will
TriWest Creates Transition Web Page On April 1, 2013, the TRICARE West Region contract will transition to and be managed by another contractor. TriWest Healthcare Alliance (TriWest) has created a special web page to help providers understand the timing and key information about the TRICARE transition. The Provider Transition Update Center is your home for specific information on important deadlines, online submission and status of referrals/authorizations and claims, claims issues resolution, your status as a TRICARE network provider, frequently asked questions (FAQs), and much more. Visit the site often as information is considered valid as of the publication date, and may change as the transition progresses. Please refer to TriWest.com/Provider>TransitionUpdateCenter frequently for updates.
(continued on p. 3)
BLUE SHIELD REPORT S-2-13 March 20, 2013
Current Procedural Terminology 2012 American Medical Association. All Rights Reserved. Note: Codes published herein are current on the publication/effective date and are subject to change.
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Don’t Wait . . . UPDATE! (continued from p. 2) prevent unnecessary phone calls to your office in the future by our staff. We ask that you communicate this information to us by using the Provider Change of Information Form on our Web site: http://www.bcbsks.com/CustomerService/Forms/pdf/15-141_ProvInfoChange.pdf If you have any questions, contact Provider Network Services at 1-800-432-3587, option 1, or e-mail us at [email protected].
Pharmaceutical Formulary Update Prime Therapeutics updates the BCBSKS formulary (preferred medication list) on a quarterly basis. Please refer to the link below when prescribing or dispensing medications for your Blue Cross and Blue Shield of Kansas patients. Coverage is subject to the limitations of the member's individual plan.
• https://www.myprime.com/MyRx/MyRxHealth/forms/KS_Alpha_Drug_List.pdf
A searchable version of the formulary is available at:
• https://www.myprime.com/MyRx/MyPrime/Commercial/findDrugs/KSBCBS/SAMST#ViewFindDrugsEvent
Do you know you can contact Provider Network Services via e-mail, too? Meeting your needs and being available to you is our priority. However, since the kick-off of CAP provider network credentialing, you may have had a longer wait than usual when calling in. If you would rather, you can always e-mail us at [email protected], and we will get back to you as soon as possible. Be sure to include a SUBJECT line as well as your provider NPI and contact phone number in case additional information is needed to respond to your inquiry.
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National Drug Code (NDC) Format Change
The HIPAA 5010 standard NDC format requires 11 digits, even though the FDA only assigns 10 digits. A leading zero must be added to the appropriate segment to bring the total digits to 11. There are three segments: the first segment identifies who packaged the product and will have 4 or 5 digits, the second segment identifies the drug and will have 3 or 4 digits, and the third segment represents the package size and will have 1 or 2 digits. A leading zero must be added to the appropriate segment to bring it to the 5-4-2 HIPAA format.
Below are examples to assist with the formatting of the NDC:
5555-4444-22 would become 05555-4444-22 55555-444-22 would become 55555-0444-22 55555-4444-2 would become 55555-4444-02
Another issue with the NDC that providers may be experiencing is not having an NDC on file with Medispan or First Data Bank (FDB). For example, a product is packaged for sale in a carton of 10 with the required package insert. This package of 10 would have an NDC on file because that is how the drug is available for purchase. The NDC on the carton of 10 might be 55555-4444-11. This is the NDC that should be used. However, each of the individual vials in the package might have an NDC of 55555-4444-10; there is no consistency for the package size details. If this drug is not available for purchase as a package of one, NDC 55555-4444-10 may not be in the drug data base, and would be denied. For this example, the NDC on the carton is the one that must be submitted.
Web Changes - Medical Policy
Since the publication of Blue Shield Report S-11-12, the following new or revised medical policies have been posted to our Web site at: http://www.bcbsks.com/CustomerService/Providers/MedicalPolicies/policies.htm
• Ambulatory Blood Pressure Monitoring • Ambulatory Event Monitors and Mobile Outpatient Cardiac Telemetry • Antihypertensive Medications • Artificial Intervertebral Disc: Cervical Spine • Artificial Intervertebral Disc: Lumbar Spine • Axial Lumbosacral Interbody Fusion (Formerly titled: Percutaneous Axial Anterior
Lumbar Fusion) • Barrett’s Esophagus Ablative Treatments • Biologic Immunomodulators Therapy • Botulinum Toxin (BT) • BRCA1 & BRCA2 Testing • Cardiovascular Magnetic Resonance (CMR) • Cardioverter-Defibrillators • Contrast-Enhanced Computed Tomography Angiography (CTA) for Coronary
Artery Evaluation
The NDC number should appear in box 19 or in the upper half of box 24A on the paper claim form.
The associated J-code should appear in box 24D of the paper claim form.
BLUE SHIELD REPORT S-2-13 March 20, 2013
Current Procedural Terminology 2012 American Medical Association. All Rights Reserved. Note: Codes published herein are current on the publication/effective date and are subject to change.
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Web Changes - Medical Policy (continued from p. 4)
• Cytochrome p450 Genotyping • Denosumab (Prolia and Xgeva) • Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome • Eye Movement Desensitization and Reprocessing (EMDR) for Acute Stress
Disorder and Post Traumatic Stress Disorder (PTSD) • First Trimester Detection of Down Syndrome Using Fetal Ultrasound Markers
Combined with Maternal Serum Assessment • Functional Neuromuscular Electrical Stimulation for Home Use • Fundus Photography • Gene-Based Tests for Screening, Detection, and/or Management of Prostate
Cancer • Gene Expression Assay for Breast Cancer Treatment • Genetic Testing for Helicobacter pylori Treatment • Genetic Testing for Inherited Susceptibility to Colon Cancer, Including
Microsatellite Instability Testing • Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy • Genetic Testing for Tamoxifen Treatment • Genetic Testing for Warfarin Dose • Glucose Test Strips/Disks and Meters • Identification of Microorganisms Using Nucleic Acid Probes • Implanted Peripheral Nerve Stimulator (PNS) for Pain Control • Kalydeco™ (ivacaftor) (Formerly known as: Kalyceco™ (ivacaftor) Prior
Authorization (with Quantity Limit) Program Summary) • KIF6 Genotyping for Predicting Cardiovascular risk and/or Effectiveness of Statin
Therapy • Laboratory Tests for Heart Transplant Rejection (New Policy) • Low-Level Laser Therapy (Formerly known as: Low-Level Laser Infrared Therapy
(aka soft laser therapy, Microlight 830, and cold laser therapy)) • Lysis of Epidural Adhesions • Magnetic Resonance Imaging (MRI) Breast • Microarray-Based Gene Expression Testing for Cancers of Unknown Primary
(Formerly known as: Gene Expression Testing for Cancers of Unknown Primary) • Monochromatic Infrared Energy (Anodyne®) aka Anodyne Therapy • Periodontal Soft Tissue Grafting • Pharmacogenomic and Metabolite Markers for Patients Treated with Thiopurines • Positron Emission Tomography (PET) • Radiofrequency Catheter Ablation of the Pulmonary Veins as Treatment for Atrial
Fibrillation • Sacral Nerve Neuromodulation / Stimulation for Pelvic Floor Dysfunction • Scanning Computerized Ophthalmic Diagnostic Imaging Devices • Screening for Lung Cancer Using CT Scanning • Self Administered Oncology Agents (Formerly known as: Self Administered
Oncology Agents Prior Authorization Criteria) • Stereotactic Radiosurgery and Radiotherapy • Subtalar Arthroeresis • Surgical Treatment of Gynecomastia • Tissue-Engineered Skin Substitutes • Transcranial Magnetic Stimulation (TMS) as a Treatment of Depression and Other
Psychiatric Disorders • Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease • Treatment of Tinnitus • Ultrafiltration in Decompensated Heart Failure (New Policy) • Varicose Veins • Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small
Bowel, Esophagus, and Colon
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BCBSKS Recognizes Six Hospitals as Blue Distinction Centers
Six hospitals providing service to our members in northeast, south central and south eastern Kansas are being recognized by the Blue Distinction Centers for Specialty Care® program in the areas of Spine Surgery and/or Knee and Hip Replacement.
The Blue Distinction Centers for Specialty Care program, which began in 2006, expanded recently to include new cost-efficiency measures, as well as more robust quality measures focused on improved patient health and safety. Blue Distinction Centers are recognized for their expertise in delivering quality specialty care while Blue Distinction Centers+ are recognized for their expertise in quality and cost efficiency in delivering specialty care.
“Earning the Blue Distinction designation is not easy. It takes a tremendous commitment to quality in all phases of a hospital’s specialty care program to meet Blue Distinction’s nationally established, objective measures,” says Andy Corbin, president/CEO. “Only six hospitals in our 103-county service area have successfully gone through the rigors of achieving such designation, and they are to be congratulated. It is impressive that four of these six hospitals were further recognized for attaining cost efficiency in delivering this high-quality care.”
These hospitals have earned Blue Distinction Center+ recognition for their expertise in quality and cost efficiency in the following specialties:
• Labette Health, Parsons, Blue Distinction Center+ for Knee and Hip Replacement
• St. Francis Health Center, Topeka, Blue Distinction Center+ for Knee and Hip Replacement; Blue Distinction Center+ for Spine Surgery
• Via Christi Hospital on St. Francis, Wichita, Blue Distinction Center+ for Knee and Hip Replacement
• Wesley Medical Center, Wichita, Blue Distinction Center+ for Knee and Hip Replacement; Blue Distinction Center+ for Spine Surgery
These hospitals have earned Blue Distinction Center recognition for their expertise in delivering quality care in the following specialties:
• Mercy Regional Health Center, Manhattan, Blue Distinction Center for Knee and Hip Replacement
• Stormont-Vail HealthCare, Topeka, Blue Distinction Center for Knee and Hip Replacement; Blue Distinction Center for Spine Surgery
Both Via Christi and Mercy Regional are being designated as Blue Distinction Centers for the first time; the other four facilities have previously been honored.
BLUE SHIELD REPORT S-2-13 March 20, 2013
Current Procedural Terminology 2012 American Medical Association. All Rights Reserved. Note: Codes published herein are current on the publication/effective date and are subject to change.
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National Walk @ Lunch Day – April 24, 2013 In your role as a health care provider, you have probably more than once extolled the virtues of walking to your patients, employees, family and friends. For the next few weeks you can focus your efforts on one specific event: April 24 is National Walk @ Lunch Day®!!
Blue Cross and Blue Shield of Kansas, together with Blue Cross and Blue Shield companies across the country, has set aside this special day as a reminder to members and Kansans to incorporate exercise into their busy schedules. In its seventh year, National Walk @ Lunch Day events have attracted tens of thousands of walkers across the United States. To celebrate this special day and encourage Kansans to “Turn a Working Lunch into a Walking Lunch,” hundreds of BCBSKS employees will lead walks in Topeka, Salina and Wichita. You can participate in National Walk @ Lunch Day by joining in one of these walks or by organizing a 20 or 30-minute activity for your employees. Or, you could simply encourage them to get out and get moving April 24.
Later this month, additional information and a variety of promotional materials – such as posters, flyers, postcards and employee communication pieces – will be available at www.bcbsks.com. You may download any of these pieces to promote one of the walks in Topeka, Salina or Wichita, or an event you organize for your employees.
Inactive Providers In an effort to keep our contracting provider records up to date, BCBSKS will begin inactivating provider numbers that have not had claim activity for 15 months or longer, beginning April 1, 2013.
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Medical Record Request for FEP HEDIS The Blue Cross and Blue Shield Association (BCBSA) is required to participate in the annual HEDIS® (Healthcare Effectiveness Data and Information Set) project for the Government-wide Service Benefit Plan (commonly referred to as BCBSA’s Federal Employee Program or FEP®). The HEDIS project is intended to measure the quality of care that Federal employees receive and includes performance measurement of administrative (claims) and clinical activities by medical record review. A portion of this project requires a review of your medical records to determine how well the member’s blood pressure is controlled if diagnosed with hypertension. BCBSA/FEP contracted with an independent vendor, Altegra Health, to conduct this medical record review. Your office will be receiving a letter from FEP outlining the process and details of the project. Thank you in advance for your cooperation with the Altegra team, and the time and effort you will provide in support of this project.
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