RFI – REQUEST FOR INFORMATION BlueCare Tennessee Clinical Laboratory Services RFI #04202015 BlueCross BlueShield of Tennessee 1 Cameron Hill Circle Chattanooga, TN 37402 ________________________________________________________________________________________ RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Services Page 1 of 9
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RFI – REQUEST FOR INFORMATION
BlueCare Tennessee Clinical Laboratory Services
RFI #04202015
BlueCross BlueShield of Tennessee 1 Cameron Hill Circle
Chattanooga, TN 37402
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Table of Contents 1 REQUEST FOR INFORMATION (RFI) ....................................................................... 3
1.1 RFI Purpose, Background and Intent ................................................................. 3
Attachment A – Confidentiality and Non-Disclosure Agreement (CNDA) ........................ 9
Attachment B – Pricing Proposal Medicaid BCT and TCS .............................................. 9
Attachment C – Pricing Proposal Medicare Advantage ................................................... 9
Attachment D – Pricing Proposal BlueCare Plus (DSNP) ............................................... 9
Attachment E – BlueCare Tennessee Lab Exclusion List ............................................... 9
Attachment F – 2014 Lab Services Utilization by CPT Code per Line of Business ......... 9
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1 REQUEST FOR INFORMATION (RFI)
1.1 RFI Purpose, Background and Intent BlueCare Tennessee is distributing this RFI to seek and gather input, suggestions, and feedback as we conduct a market check for the following lines of business: BlueCare Tennessee, BlueCare Plus, TennCareSelect and Medicare Advantage (collectively herein referred to as “BCT”), for the provision of excellent quality and efficient healthcare to our members through Point of Service Laboratory Testing or Traditional clinical laboratory services. This RFI is intended to provide interested Providers with information to enable them to demonstrate their capabilities to provide clinical laboratory services to improve members’ health outcomes, increase patient satisfaction with care, control expenditures, as well as propose creative, competitive solutions for value-added services, i.e., Member Home Visits, Home Kits, and multiple community outreach opportunities. Responses should include a summary of how the Provider would administer and deliver Point of Service Laboratory Testing or Traditional clinical laboratory services statewide, as well develop and implement value-added services: Member Home Visits, Home Kits, and community outreach events. Provider should submit a response describing their Provider network, authorization, coordination, scheduling management and reimbursement protocols. Provider must be capable of filing claims. Providers are required to submit cost models designed to include a fee-for-service arrangement for each line of business. This RFI is issued solely for information and planning purposes. It does not constitute a Request for Proposal (RFP) or a guarantee to issue an RFP in the future. This RFI does not commit BCT to contract for any supply or service. Responders should be advised that BCT will not pay for any information or administrative costs incurred in response to this RFI; all costs will be solely at the interested party’s expense. Not responding to the RFI does not preclude participation in any possible, future RFP; if an RFP is issued, qualified candidates will be notified. 2 CORPORATE OVERVIEW
2.1 BlueCross BlueShield of Tennessee (BCBST) BlueCross BlueShield of Tennessee, Inc., headquartered in Chattanooga, Tennessee is committed to conducting business with ethics, integrity and in accordance with all federal, state and local laws and regulations. The compliance, risk and quality management program model enables the communication and oversight necessary for this commitment. Additional information concerning the organization, operation, goals and objectives of BCBST is available from our website, at http://www.bcbst.com.
2.2 BlueCare Tennessee (BCT) BCT is an independent licensee of the BlueCross BlueShield Association and a licensed HMO affiliate of its parent company BlueCross BlueShield of Tennessee, Inc. Founded in 1993, the Chattanooga-based company focuses on managing care and providing quality health care products, services, and information for the State of Tennessee’s TennCareSM programs. BCT contracts with the State of Tennessee, through the Bureau of TennCare, to manage and deliver integrated physical health, behavioral health, and long term care services to over 550,000 members statewide. A primary goal for BCT is helping TennCare members become healthier. Explore our Web site and learn more about us at http://bluecare.bcbst.com.
2.3 TennCareSelect (TCS) TennCareSelect is the State’s self-insured TennCare Health Maintenance Organization that is available to select TennCare Enrollees effective July 1, 2001. It is administered by BCT and has the same benefits as all other MCO’s. TennCare Enrollees cannot choose TennCareSelect, only the Bureau of TennCare can enroll members. Some of the State's groups for TennCareSelect include:
• Children receiving Social Security Insurance (SSI) benefits;
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• Children who are in the custody of the state; • Children who are in an institutional eligibility category; • Enrollees with intellectual disabilities; • and Enrollees who may be temporarily living out of state.
In some areas of the state, other TennCare MCOs cannot serve all Enrollees. TennCareSelect is the backup program in those areas.
2.4 BlueCare Plus HMO DSNP BlueCare Plus is an Independent Licensee of the BlueCross BlueShield Association. BlueCare Plus is an HMO Special Needs Plan (SNP) with a Medicare contract and a contract with the Tennessee Medicaid Program. BlueCare Plus focuses on managing care and providing quality health care products, services, and information for government programs. We take great pride in serving the people of Tennessee statewide, both in our products and services and in our numerous outreach activities. BlueCare Plus is an HMO SNP plan that works with each member and a team of professionals to offer the most appropriate programs to meet physical, behavioral health and long-term care needs ranging from preventive initiatives to care coordination. The BlueCare Plus program is designed for people who have Medicare (Parts A and B) and Medicaid with unique special needs, the program operates as the individual's point of contact for both Medicare and Medicaid benefits and services. Part D prescription drug coverage is included in the BlueCare Plus program with the addition of vision, hearing, dental and transportation benefits for our BlueCare Plus members.
2.5 State of Tennessee TennCare Program TennCare is the State of Tennessee’s Medicaid program that provides health care services for 1.2 million Tennesseans and operates with an annual budget of approximately 8 billion dollars. The TennCare program operates under a Section 1115 waiver from the Centers for Medicare and Medicaid Services (CMS) in the United States Department of Health and Human Services. It is a demonstration program. The principle being demonstrated by TennCare is that a state can organize its Medicaid program under a managed care model and generate sufficient savings to extend coverage to additional populations who would not otherwise be Medicaid eligible, without compromising quality of care. TennCare is one of the oldest Medicaid managed care programs in the country, having begun on January 1, 1994. It is the only program in the nation to enroll the entire state Medicaid population in managed care. The State of Tennessee contracts with managed care organizations for the administration of the TennCare programs under the Contract Risk Agreement (CRA) and the TennCareSelect Agreement (TSA). Provider(s) will need to base their RFI responses on the CRA, including Amendment 13, and the TSA, including Amendment 33 as well as the State wide Agreement effective January 1, 2015. The documents can be downloaded from the following links: http://www.tn.gov/tenncare/forms/eastwestmcocontract.pdf On January 1, 2015, a new five-year contract took effect extending our 20-year partnership of service to the State of Tennessee and our TennCare members.
2.6 Medicare Advantage Medicare Advantage Program - BCBST contracts with Medicare to provide a Medicare Advantage Plan offering four Medicare Advantage Local Preferred Provider Organization (LPPO) products. BlueAdvantage (PPO) BlueCross BlueShield of Tennessee offers four Medicare Advantage Preferred Provider Organization (PPO) products: BlueAdvantage Diamond, BlueAdvantage Ruby, BlueAdvantage Garnet and BlueAdvantage Sapphire. Currently, the four PPO products are available in all 95 counties.
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BlueChoice (HMO) BlueCross BlueShield of Tennessee offers two Medicare Advantage Health Maintenance Organization (HMO) products: BlueChoice and BlueChoice Plus. Currently, the two HMO products are available in 65 counties: Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Cheatham, Chester, Claiborne, Cocke, Coffee, Cumberland, Davidson, DeKalb, Fayette, Franklin, Gibson, Giles, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hardeman, Hawkins, Henry, Hickman, Jackson, Jefferson, Knox, Lawrence, Lewis, Lincoln, Loudon, Madison, Marion, Marshall, Maury, Meigs, Monroe, Montgomery, Morgan, Overton, Perry, Polk, Rhea, Roane, Robertson, Rutherford, Sequatchie, Sevier, Shelby, Smith, Sullivan Sumner, Trousdale, Union, Warren, Wayne, White, Williamson and Wilson.
2.7 Target Population
The Provider must be able to provide and manage Point of Service Laboratory Testing or Traditional clinical laboratory services to all BCT members throughout the State of Tennessee and its contiguous counties. BCT reserves the right to carve out certain codes and geographical areas from this RFI. BCT currently serves approximately the following number of members:
Region Name Region Location Total Membership as of 3/31/2015 BCT East East Grand Region 187,724 BCT West West Grand Region 146,709
BCT Middle Middle Grand Region 141,049 TennCareSelect Statewide 49,047
3.1 Proprietary or Confidential Information Any information contained in the RFI responses is proprietary or confidential must be clearly designated. Be advised that all submissions become the Property of BCT and will not be returned. BCT will maintain the confidentiality of Provider’s Information marked “Confidential” of “Proprietary” in accordance with applicable laws. Interested Providers are required to read, sign, and return the included Non-Discrimination Agreement, Attachment A with their RFI responses on or before May 22, 2015.
3.2 Amendment/Addenda/Right to Cancel BCT reserve the right to alter and/or cancel the RFI timeline or other portions of this RFI at any time.
3.3 Submission Instructions Interested parties who need additional information or have questions about this RFI may submit “RFI QUESTIONS” electronically to [email protected] on or before 5 PM (EST) April 30, 2015.
All final RFI responses must be submitted at a minimum in Microsoft Office 2007 compatible software version. Responses are due by May 22, 2015.
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3.4 Industry Discussions At our discretion, BCT may or may not choose to contact responders. In the event we choose to contact responders, such contact and discussions are only intended to gain additional clarification of the Provider’s potential capability to meet the service requirements.
3.5 Submittal of Questions Questions regarding this Request for Information shall be submitted via e-mail to [email protected], please clearly indicate “RFI Lab Services” in the Subject line of all emails. Verbal questions will not be accepted. Questions shall not contain proprietary information. We do not guarantee a response to questions received within two (2) days of the due date.
3.6 Point of Contact for BCT and Deliverables The point of contact for this RFI and all deliverables should be emailed to:[email protected]. Clearly indicate “RFI Lab Services” in the Subject line of all emails.
3.7 RFI Planned Schedule
Action Date Time (ET) RFI Issued to Providers 4/22/2015 5 PM Receipt of Provider Questions 4/30/2015 5 PM BCT Response to Provider Questions 5/7/2015 5 PM RFI Response Due 5/22/2015 5 PM
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Contact Person’s Name and Title: Contact’s Email Address:
Contact’s Phone Number:
Organizational Background
4.2 Provide a brief history on your organization including headquarters, divisions and operations. Include how long your organization has been in operation and whether it is owned by a parent company, or whether it owns other companies as a parent organization.
4.3 Submit a description of your major facilities.
4.4 Does your organization have the capability to deliver Point of Service Laboratory Testing or Traditional
Clinical Laboratory Services statewide for both physician office practices and facilities?
4.5 Does your organization hold an unrestricted license in Tennessee?
4.6 Describe Medicare certifications currently held.
4.7 Provide a copy of all certifications obtained by your laboratory.
4.8 Provide a listing of Point of Service testing available and Traditional lab testing with turnaround time from draw to results submission to ordering provider.
4.9 Provide an outline of Provider’s Quality Improvement and Utilization Review program.
4.10 Describe prior authorization services for esoteric and pathology labs.
4.11 Provide a list of available testing by CPT code.
4.12 Does your organization meet the National Committee for Quality Assurance (NCQA) accreditation?
4.13 What differentiates you from your competitors?
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Service and Access
4.14 For each of your locations, list services provided. Indicate service availability in Tennessee and its contiguous counties (if partial counties, please note). Where only limited services are offered, please indicate and explain. Where additional services are provided, please details.
4.15 Do you provide services on a 24-hour basis? In what manner? Please describe processes of receiving
request for services (from patient, from physician, from emergency department), dispatching care, and following up with regular provider (if applicable). Please provide your turnaround time for results of lab testing to be available for the ordering provider.
4.16 How many patients do you service a day? Describe your capacity to accept additional patients, without
restricting quality or access to services. Describe experience dealing with large fluctuations in service demand.
4.17 Describe, in detail value-added services/programs your organization has successfully implemented. Describe the focus of the value-added services/programs, the method of implementation, and document program results. Tell us about any lessons learned with these value-added services/programs.
4.18 Which value-added services/programs does your organization recommend for each BCT line if business as part of your RFI response? Why?
Staff Selection and Training
4.19 Describe Provider’s screening process for recruiting employees and monitoring existing employees. Describe sanctioned background check processes.
4.20 Does Provider provide training for its staff? Describe training content and curriculum,
Payment/Administrative
4.21 Describe your organization’s electronic billing capabilities and willingness to use BCT billing format – HL7.
4.22 Describe the payment models you believe have been most successful in the delivery of the Point of Service Laboratory Testing or Traditional Clinical Laboratory Services.
4.23 What cost saving initiatives have you previously implemented?
4.24 Does your organization have the ability to provide laboratory values electronically?
4.25 Please include samples of standard reports.
4.26 Describe a timeline for operational readiness from the time of a potential contract award date to full
implementation.
4.27 After review of the State and Federal CMS Contracts requirements, are there any requirements that you believe that your organization could not comply with or would provide significant challenges?
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RFI Attachments
Attachment A – Confidentiality and Non-Disclosure Agreement (CNDA) See separate document for review and signature.
Attachment B – Pricing Proposal Medicaid BCT and TCS See attachment Attachment C – Pricing Proposal Medicare Advantage See attachment Attachment D – Pricing Proposal BlueCare Plus (DSNP) See attachment Attachment E – BlueCare Tennessee Lab Exclusion List See attachment Attachment F – 2014 Lab Services Utilization by CPT Code per Line of Business See attachment
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Attachment A
Confidentiality and Non-Disclosure Agreement (CNDA)
This Confidentiality and Non-Disclosure Agreement (“Agreement”) is entered into by and between BlueCross BlueShield of Tennessee, Inc., for itself and on behalf of its Affiliates and Representatives, (Collectively “BCBST”), and , for itself and on behalf of its Affiliates and Representatives, (Collectively “________”), and shall be effective on and after the date of the last signature executed below (its “Effective Date”). Recitals. BCBST and _______ may be collectively referred to as the “Parties” or individually referred to as a “Party”, “Disclosing Party”, “Receiving Party”, or “Recipient” and have requested that each Party furnish the other with certain information which is considered confidential and proprietary. Each Party may also obtain additional information regarding the other during the course of discussions between the Parties that prompted the original request for information (the “Parties’ Discussions”). The purpose of this Agreement is to set forth the terms and conditions under which such information will be disclosed concerning the BCT Clinical Laboratory Services RFI (“Subject Program”). As an inducement to each Party furnishing the other with the information, and as a condition to each Party furnishing such information to the other, each Party agrees that it will, and will cause each of its Representatives (as defined herein) to comply with the provisions hereof. 1. For purposes of this Agreement, the term “Affiliates” is that which is defined in Subpart
2.1 of the FAR.
2. “Confidential Information” shall mean all oral and written information in any form or medium, concerning the subject matter of the Parties’ Discussions, and shall include, but is not limited to, technical, business or financial information, and that is: 1) is marked with the legend “CONFIDENTIAL INFORMATION” or an equivalent conspicuous legend, otherwise identified as, legally entitled to protection as, or is of the type or nature that a reasonable person would understand it to be confidential, proprietary, privileged or trade secret information; or (2) if it disclosed orally or visually, and is identified as Confidential at the time of disclosure and is subsequently reduced to writing specifically identifying the items of a Confidential nature and is furnished to the Recipient within fifteen (15) days of disclosure; or (3) is disclosed by or on behalf of a Party (the “Disclosing Party”) to the other Party (the “Receiving Party”) related to the Parties’ Discussions. Confidential information includes information by the Disclosing Party, as well as all copies. If Confidential Information includes “Protected Health Information” as that term is defined in 45 C.F.R. Section 160.103 of the federal privacy regulations, and would be subject to the protections pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), then each Party shall comply, not only with this Agreement with respect to such Protected Health Information that is part of Confidential Information, but also with the HIPAA regulations at 45 C.F.R. Parts 160 and 164 pertaining to the privacy and security of Protected Health Information to the extent that such HIPAA regulations are applicable to such Party, including the execution of appropriate and mutually agreeable Business Associate Agreements pursuant to such regulations.
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The term “Confidential Information” does not include information that: (1) is based on documents in the Receiving Party’s possession prior to disclosure of information and was not acquired directly or indirectly from the Disclosing Party; or (2) was in the public domain at the time of disclosure, or subsequently became part of the public domain through no fault of Receiving Party; or (3) was legally received on a non-confidential basis from a third party, who is not known to be bound by a confidentiality agreement preventing the disclosure of such information; or (4) was independently developed by the Receiving Party without reliance on or knowledge of the Disclosing Party’s Confidential Information.
3. “Representatives” means a Party’s officers, directors, members, employees, or consultants, who receive Confidential Information and/or participate in the Parties’ Discussions pursuant to this Agreement.
4. The Receiving Party agrees that it will, and will cause its Representatives to, maintain in
confidence all Confidential Information. In this regard, the Receiving Party agrees to disclose Confidential Information only to Representatives who need to know such information for the purpose of the Parties’ Discussions and shall take all necessary and reasonable precautions to prevent such Confidential Information from being disclosed or provided to any unauthorized person. The Receiving Party agrees that it will not, and will cause its Representatives not to, use Confidential Information for any purpose other than the purpose of the Parties’ Discussions without first obtaining the Disclosing Party’s express written consent. Receiving Party shall be responsible for any improper disclosure or use of Confidential Information by any of its Representatives. The term “person” as used in this Agreement will be interpreted broadly to include, without limitation, any corporation, company, partnership, limited liability company, natural person or government entity.
5. In the event the Receiving Party or any of its Representatives is requested or becomes legally compelled (by deposition, interrogatory, request for documents, subpoena, civil investigative demand or similar process) to disclose any Confidential Information, then the Party so requested or compelled shall provide the Disclosing Party with prompt written notice of such request or requirement so that the Disclosing Party may seek a protective order or other appropriate remedy and/or waive compliance with the terms of this Agreement. In the event that such protective order or other remedy is not obtained, or that the Disclosing Party waives compliance with the provisions hereof, the Party so requested or compelled agrees to furnish only that portion of the Confidential Information that it is advised by counsel is legally required to be disclosed and to exercise reasonable efforts to obtain assurance that confidential treatment will be accorded the Confidential Information.
6. Upon written notice from the Disclosing Party, the Receiving Party agrees to immediately return or destroy all Confidential Information and any copies in whatever medium utilized containing any such Confidential Information. In addition, the Receiving Party agrees to destroy all copies of any analyses, compilations and studies or other documents including notes and other writings that it prepared containing or reflecting any Confidential Information., Each Party, however, shall be entitled to retain copies of any computer records and files which have been created pursuant to its automatic electronic archiving and back up procedures.
7. Except as may be necessary, in the opinion of counsel, to comply with the requirements of law, governmental regulation or any securities exchange on which any securities of
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either Party hereto may be listed, without the prior written consent of the Disclosing Party, the Receiving Party will not, and will direct its Representatives not to, disclose to any person either the fact that the Parties Discussions or that the Disclosing Party or the Receiving Party has requested or received any information, including Confidential Information, from the other Party, or any terms, conditions or other facts with respect to the Parties Discussions, including the status thereof.
8. The parties agree that remedies at law for any actual or threatened breach by Receiving Party of the provisions of this Agreement would not be sufficient remedy. Accordingly, the Receiving Party acknowledges and agrees in advance that in the event of any actual or threatened breach of the provisions of this Agreement by it, and without prejudice to any rights and remedies otherwise available to the Disclosing Party, the Disclosing Party may be entitled (a) to equitable relief, including by way of injunction and/or (b) to compel specific performance without the need of proof of actual damages.
9. Nothing in this Agreement shall be construed as establishing any joint venture or other business relationship or as granting any license or right under any patent rights or as representing any commitment by either Party to enter into any license or other agreement by implication or otherwise.
10. It is the intention of the Parties that the provisions of this Agreement shall be enforced to the fullest extent permissible under the laws and public policies of each state and jurisdiction in which such enforcement is sought, but that the unenforceability (or the modification to conform with such laws or public policies) of any provision hereof shall not render unenforceable or impair the remainder of this Agreement which shall be deemed amended to delete or modify, as necessary, the invalid or unenforceable provisions. The Parties further agree to alter the balance of this Agreement in order to render the same valid and enforceable.
11. This Agreement constitutes the full understanding of the Parties and a complete and exclusive statement of the terms and conditions of their agreement relating to the subject matter hereof and supersedes any and all prior agreements, whether written or oral, that may exist between the Parties with respect thereto. Except as otherwise specifically provided in this Agreement, no conditions, usage of trade, course of dealing or performance, understanding or agreement purporting to modify, vary, explain or supplement the terms or conditions of this Agreement shall be binding unless hereafter made in writing and signed by both Parties to be bound, and no modification shall be effected by the acknowledgment or acceptance of documents or forms containing terms or conditions at variance with or in addition to those set forth in this Agreement.
12. The restrictions expressed in this Agreement are in no way to supersede or eliminate any rights which the Parties otherwise may have pursuant to state or federal law pertaining to trade secrets or proprietary information.
13. It is further understood and agreed that no failure or delay by either Party in exercising any right, power or privilege hereunder shall operate as a waiver thereof, nor shall any single or partial exercise thereof preclude any other or further exercise thereof or the exercise of any right, power or privilege hereunder.
14. This Agreement will be governed by and construed in accordance with the laws of the State of Tennessee
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15. This Agreement shall be binding upon and inure to the benefit of the Parties hereto and shall be binding upon and inure to the benefit of the successors, assigns, personal representatives, executors and administrators of the Parties hereto.
This Agreement may be executed by facsimile transmission and in two or more counterparts, each of which shall be deemed an original and which, when taken together, shall constitute one and the same instrument. Any signatures delivered by a Party by facsimile transmission or by e-mail transmission, including in Adobe portable document format, shall be deemed an original signature.
IN WITNESS WHEREOF, the Parties have executed this Agreement intending to be bound on and after its last signature date below, referred to as the “Effective Date”. BlueCross BlueShield of Tennessee, Inc. [Company Name] By: ______________________________ By: _______________________________ Title: _____________________________ Title: ______________________________ Signature: ________________________ Signature: __________________________ Address: _________________________ Address: ___________________________ _________________________________ __________________________________ Date: ____________________________ Date: _____________________________
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Attachment B[Offeror's Name]: Proposed Laboratory Pricing by Procedure
RFI - Clinical Laboratory Services
1
Line of Business: Medicaid - BlueCare Tennessee and TennCareSelect
NPI Tax ID CPT Code Modifier
Do you offer this service
(Y/N)
% of Medicare Proposed Comments
Attachment C[Offeror's Name]: Proposed Laboratory Pricing by Procedure
RFI - Clinical Laboratory Services
1
Line of Business: Medicare Advantage
NPI Tax ID CPT Code Modifier
Do you offer this service
(Y/N)
% of Medicare Proposed Comments
Attachment D[Offeror's Name]: Proposed Laboratory Pricing by Procedure
RFI - Clinical Laboratory Services
1
Line of Business: BlueCare Plus - DSNP
NPI Tax ID CPT Code Modifier
Do you offer this service
(Y/N)
% of Medicare Proposed Comments
Updated March 19, 2015CPT® is a registered trademark of the American Medical Association
CPT® Code Description36415 Collection of venous blood by venipuncture36416 Collection of capillary blood specimen (eg, finger, heel, ear stick).36591 Collection of blood spec from implantable device (port)36592 Collection of blood specimen from central line, venous
*80299 Methotrexate81000 Urinalysis, by dip stick or tablet reagent; non-automated, with microscopy81001 Urinalysis, by dip stick or tablet reagent; automated, with microscopy81002 Urinalysis, by dip stick or tablet reagent; non-automated, without microscopy81003 Urinalysis, by dip stick or tablet reagent; automated, without microscopy81005 Urinalysis; qualitative or semiquantitative, except immunoassays81025 Urine pregnancy test, by visual color comparison methods82044 Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay)82140 Ammonia82150 Amylase82247 Bilirubin; Total82248 Bilirubin; Direct82270 Blood, occult, by peroxidase activity, multiple specimen82272 Blood, occult, by peroxidase activity, single specimen
The Primary Criteria for the Exclusion List is as follows: Test Results needed in an Outpatient Setting to Facilitate Immediate care of the Patient.
NOTE: Codes added during the Q1 2014 review are indicated by green highlights
BlueCare Tennessee Lab Exclusion List
BCT RFI - ATTACHMENT E
Updated March 19, 2015CPT® is a registered trademark of the American Medical Association
82805 Gases, blood with O2 saturation, by direct measurement, except pulse oximetry82810 Gases; Blood O2 saturation only
82820 Hemoglobin-oxygen affinity (pO2 for %50 hemoglobin saturation with oxygen)
82945 Glucose, body fluid, other than blood (CSF)82947 Glucose; quantitative, blood (except reagent strip)82948 Glucose; blood, reagent strip82950 Glucose; Post Glucose Dose82951 Glucose tolerance test, 3 specimens (includes glucose)82962 Glucose, blood by glucose monitoring device(s) 83014 Helicobacter pylori; drug administration83037 Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use83605 Lactate
85025Blood count; hemogram and platelet count, automated, and automated complete differential WBC count (CBC)
85049 Blood count; platelet automated85060 Blood smear, peripheral; with written report85378 Fibrin degradation products, D-dimer; qualitative85379 Fibrin Degradation Products, D-Dimer; quantitative85460 Hemoglobin, fetal for fetomaternal hemorrhage85576 Platelet aggregation, each agent85610 Prothrombin time85611 Prothrombin time substitution, plasma fractions, each85652 Sedimentation rate, erythrocyte, automated85660 Sickling of RBC, reduction85730 Thromboplastin time, partial (PTT); plasma or whole blood85732 Thromboplastin time, partial (PTT); substitution, plasma fractions, each86308 Heterophile antibodies; screening86318 Immunoassay for infectious agent antibody, single step86485 Skin test; candida86486 Skin test; unlisted antigen, each86490 Skin test; coccidioidomycosis86510 Skin test; histoplasmosis86580 Skin test; tuberculosis, intradermal86710 Antibody; influenza virus86738 Antibody; Mycoplasma86850 Antibody screen, RBC, each serum technique86860 Antibody elution (RBC), each elution86870 Antibody identification, RBC antibodies, each panel for each serum technique86880 Antihuman globulin test (Coombs test); direct, each antiserum86885 Antihuman globulin test (Coombs); indirect, qualitative, each reagent red cell86900 Blood Typing; ABO86901 Blood Typing; RH (D)
86902 Blood typing; antigen testing of donor blood using reagent serum, each antigen test86904 Antigen screen for compatible unit, patient serum86920 Compatability test each unit; immediate spin technique86921 Compatability test each unit; incubation technique
BlueCare Tennessee Lab Exclusion List
BCT RFI - ATTACHMENT E
Updated March 19, 2015CPT® is a registered trademark of the American Medical Association
86922 Compatability test each unit; antiglobulin technique86923 Compatability test each unit; electronic86927 Thawing fresh frozen plasma86931 Thawing frozen blood86965 Pooling of platelets or other blood products86970 Pretreatment of RBCs with chemical agents86971 Pretreatment of RBCs with enzymes86975 Pretreatment of serum with drugs86976 Pretreatment of serum by dilution86977 Pretreatment of serum with inhibitors86978 Pretreatment of serum by differential red cells86985 Splitting of blood products
87205Smear, primary source with interpretation, Gram or Giemsa stain for bacteria, fungi, or cell types
87210Smear, primary source with interpretation; wet mount for infectious agents (e.g., saline, India ink, KOH preps)
87220Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites
87400Infectious agent antigen detection by enzyme immunoassay technique; Influenza, A or B, each
87430Infectious agent antigen detection by enzyme immunoassay technique; Streptococcus, group A (Rapid Strep)
87802Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B
87803Infectious agent antigen detection by immunoassay with direct optical observation; Clostridium difficile toxin A
87804Infectious agent antigen detection by immunoassay with direct optical observation; Influenza (Rapid Flu)
87807Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
87880Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A (Strep Test)
*88160 Tzanck smear
88172Cytopathology, eval of fine needle aspirate; immediate cytohistologic study to determine adequacy for dx, first episode, each site
88173Cytopathology, eval of fine needle aspirate; immediate cytohistologic study to determine adequacy for dx, first episode, each site, interpretation and report
88177Cytopathology, eval of fine needle aspirate; immediate cytohistologic study to determine adequacy for dx, each separate additional episode, same site
BlueCare Tennessee Lab Exclusion List
BCT RFI - ATTACHMENT E
Updated March 19, 2015CPT® is a registered trademark of the American Medical Association
**88300 Level I Surgical Pathology, gross exam only**88302 Level II Surgical Pathology, gross and microscopic exam **88304 Level III Surgical Pathology, gross and microscopic exam **88305 Level IV - Surg Path, Gross and Micro Exam**88307 Level V Surgical Pathology, gross and microscopic exam **88309 Level VI Surgical Pathology, gross and microscopic exam **88311 Decalcification procedure**88312 Spec Stain; Grp I for Micro Interp and Report**88313 Spec Stain; Grp II for Micro Interp and Report
88314 Histochemical stain on frozen tissue block88329 Pathology consultation during surgery88331 First tissue block, with frozen section(s), single specimen88332 Each additional tissue block with frozen section(s)
**88341Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure
**88342 Immunohistochemistry; Ea Antibody**88346 Immunoflourescent Study; Direct Method
88348 Electron microscopy, diagnostic
**88367 Morphmetric analysis; in situ hybridization, quantitative, each probe; automated88720 Bilirubin, total, transcutaneous88738 Hemoglobin (Hgb), quantitative, trancutaneous89050 Cell count, misc. body fluids89051 Cell count, misc body fluids with differential count89230 Sweat collection by iontophoresis89300 Semen Analy; Presence/Motility Incl Huhner Test89310 Semen Analy; Motility and Count89320 Semen Analysis; Complete89321 Semen Analysis Presence And/Or Motility of Sperm89330 Sperm; Cerv Mucos Penetrat W/Wo SpinnbarkeitG0434 Drug Screen by CLIA waived test, per patient encounterQ0111 Wet mounts, including preparation of vaginal, cervical or skin specimens
* Excluded for Members age 11 and younger only** Excluded for Outpatient Surgical setting only
BlueCare Tennessee Lab Exclusion List
BCT RFI - ATTACHMENT E
RFI ATTACHMENT F
BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS