2015 All Payers Workshop Presented by Blue Cross and Blue Shield of - - PowerPoint PPT Presentation

2015 All Payers Workshop

Presented by Blue Cross and Blue Shield of Kansas December 11, 2015

AGENDA

• Story Time…..
• Institutional Relations eNews
• Telemedicine
• Pre-determination and Prior Authorization
• Benefits of filing electronically
• Facility Information Change Form

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Institutional Provider Relations eNews

• Re-connect with us
• January 1, 2016
• Sign up today!

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Telemedicine

• Physician specialty not available in

the community

• Primary care services not covered
• HIPAA, state and federal compliant
• Originating site - Bill Q3014

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Predetermination and Prior Authorization

Predetermination

• Form available on the Web -

http://www.bcbsks.com/CustomerService/Form s/pdf/15-7_predeterm_request_frm.pdf

• 15 business days
• Priority predetermination approximately 3 days
• Letter will advise of decision
• Check Benefits via Availity

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Predetermination and Prior Authorization

Prior Authorization

• List available on the Web -

http://www.bcbsks.com/CustomerService/Provid ers/MedicalReview/pre-cert_pre-auth.shtml

• BRCA 1 and BRCA 2 Testing
• Human Growth Hormone
• IVIg/SCIg
• Synagis

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Benefits of filing electronically

• Earlier payment
• Earlier detection of errors
• Lower cost

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Facility Information Change Form

• New form for institutional providers to report

changes to their Provider File

• New form can be found at:

http://www.bcbsks.com/CustomerService/Forms/ pdf/15-218_FacilityProviderFileUpdate.pdf

• Form can be completed electronically, but it will

need to be printed and sent to BCBSKS by mail

• r fax.

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Thank you for attending today!

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Questions?