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What's New
1st Quarter 2010 - Formulary Updates
New Exclusive HMO and Preferred Statewide PPO/POS Clinical Reference Lab Provider Effective June 1, 2010
Change to claims run-out period for U.S. Virgin Islands
Easier Access to Pre-Certification/Pre-Authorization Information for Out-of-Area Blue Members
Availity Participating Provider Training Webinars - March 2010
Duplicate 1099 Request
Secondary Claims - Electronic Filing Guidelines
Change to HMO Blue Texas Outpatient Clinical Reference Lab Services Effective June 1, 2010
Electronic Refund Management (eRM) - March Webinars
New Be Smart. Be Well.® Topic Launches with Redesigned Site
2010 BlueCard® Program - Seeking Your Feedback
Physician Assistant and Advanced Practice Nurse Copayments
Blue Cross Member ID Cards Include Behavioral Health Pre-Cert Contact Information
Resolved: Missing Information on 835 Transaction - January 2010
Walmart 2010 Changes & Instructions
Electronic Transactions - 2010 Holiday Schedule Reminder
Pharmacy Compounding
Eligibility and Benefits Fax Back
Extended release Niacin vs. Ezetimibe: Results of the ARBITER 6-HALTS Trial
New Wellness Initiatives for Federal Employees eff January 1, 2010
Newly Designed Public Web Site Launches
System Upgrade For Medicare Crossover Claims
Untimed Billing Procedure CPT Codes - Update

Disclosure Notices
New Exclusive HMO and Preferred Statewide PPO/POS Clinical Reference Lab Provider Effective June 1, 2010
Code Auditing & Modifier 59 Exempt Auditing
Quarterly Drug & Home Infusion Drug Fee Schedule Updates effective 6/1/10 have been posted under Reimbursement Schedules as of 3/1/10
Change to HMO Blue Texas Oupatient Clinical Reference Lab Services Effective June 1, 2010
Evidence Based Reimbursement
Fee Schedule Update

Provider Education

Blue Review
Distribution date of February 8, 2010

Blue Review
Issue 1 - 2010

For Full Printable Version

Blue Review Archives
   
Electronic Commerce
  		• Alerts
  		• Availity L.L.C.
     

        • March 2010 Webinars
  		• eCare/NDAS Online
  		• EDI Format Specifications
  		• EDI Transactions
  		• EFT/ERA Forms
  		• Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA)
  		• Electronic Provider Tools Reference Guide
  		• Electronic Refund Management (ERM)
     

        • March Webinars
  		• HIPAA
  		• iEXCHANGE® Web -
    Automated Precertification
    and Referral System
     

        • Getting Set-Up with
           iEXCHANGE Web

     

        • Web Reference Guide
            • Web Tip Sheet
  		• Online Transaction Tip Sheets
  		• RealMed

    Provider Library
  		• BlueCard®
  		• BlueCompare for Physicians
  		• BlueCompare for Hospitals
  		• Bridges to Excellence
  		• Claim Appeal/ Reconsideration Review Process & Billing Dispute External Review Process (BDERP)
  		• Claim Pointers
  		• Duplicate 1099 Request
  		• Evidence Based Measures
  		• FAQs
  		• Learn More About
    • BlueChoice Solutions
    • Blue Medicare Private
       Fee-for-Service
         • Terms and Conditions
    • HealthSelect
    • TriWest
  		• National Provider Identifier
  		• Physician Advisory Committee (PAC)
  		• Provider Education
    • New Provider Orientation
    • Existing Provider
      Orientation
    • Refresher Orientation
    • Time to be Blue
  		• Provider Manuals Requires password for access
  		• Reference Guides
  		• Special Investigations Tutorial
  		• Wellness Initiatives/Programs
    General Reimbursement Information

  • Bundling Information Requires password for access
    • Clear Claim Connection
     
  		• Recoupment/Refund Requires password for access
     
  		• Schedules Requires password for access
     
  		• Significant Edits Requires password for access
     
  		• ...and more... Requires password for access

    Medical Policy

  • Draft Medical Policies

  • Active/Pending Medical Policies

     
  		• Medical Policy Medical Records Documentation Guidelines (Predeterminations/Claims)

    Credentialing/
    Contracting
  		• Physician/Professional Provider
    • Ten Great Reasons
       to be Blue
    • Provider Record/
       Credentialing
    • Areas of Interest –
       TRICARE Only
  		• Facility/Ancillary
    • Areas of Interest –
       TRICARE Only
    • Consent to
       Assignment of
       Provider Contracts
       (Change of
       Ownership-CHOW)

    UM/QI/Medical Management

  • Behavioral Health Medical Necessity Criteria
  		• Clinical Practice and Behavioral Health Guidelines
  		• Clotting Factor Product Initiative
  		• eCards for Health
  		• iEXCHANGE® - Automated Precertification and Referral System
  		• Maternity Program: A Healthy Start for Mothers and Babies
  		• Postpartum Depression - The “Andrea Yates Bill”
  		• Radiology Quality Initiative/Preauth Prgm
  		• Step Therapy Guidelines for City of Houston (COH)
     
  		• Wellness Guidelines
    		 
    Pharmacy
  		• Digitek Recall
  		• Medicare Part D Pharmacy Updates
  		• Medicine Safety Project
  		• Override Request (pdf - 18k)
  		• Preferred Drug Guide
  		• Proton Pumps (pdf - 28k)
  		• Quantity vs. Time
  		• Specialty Drug Programs
    • Triessent
    • Factor Drugs (Accredo)
    • Lupron (TAP Pharmacy   Solutions)
  		• Step Therapy/Prior Authorization
  		• Synagis & RSV
  		• Topical Verapamil

    Provider
    Tools/Programs
  		• Be Smart. Be Well.TM
    • Childhood Obesity
    • Caregiving
    • Domestic Violence
    • Drug Safety
    • Managing Pregnancy Risks
    • Mental Health
    • Sexually Transmitted    Disease (STD)
    • Traumatic Brain Injury    (TBI)
  		• Blue Distinction
  		• Care Comparison® Tool
  		• Obesity Management Tool Kit Web Site


     
     
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