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BlueCompare 2008
How to Request Reviews and Make Inquiries
Blue Cross and Blue Shield of Texas (BCBSTX) makes every effort to ensure our network physicians understand the information listed in our BlueCompare Web tool. If you are not satisfied with your BlueCompare Evidence Based Measures (EBM) information, you have the right to request a formal review.
There are two levels of review:
- The initial review is an internal review conducted by BCBSTX. Review decisions are typically reported within 30 days from our receipt of the request.
- Second-level reviews are conducted by the BCBSTX Texas Medical Advisory Committee or the BCBSTX Texas Peer Review Committee. Members of both committees are practicing physicians and other health care providers who also participate in networks serving members of BCBSTX health programs.
Second-level reviews to re-evaluate the initial review decision ordinarily must be requested by the provider. Decisions are made within 30 days from our receipt of the second-level review request. In some instances, the timeframe will be extended due to the timing of the Second- Level Review Committees’ meeting dates.
How to Request a Review
You may request a review of your updated BlueCompare EBM information by sending a written request to your local Professional Provider Network office.
Requests should include:
- the date of the request
- your name and address
- your Provider Number
- your Practice Evaluation ID Number (found on the BlueCompare letter and reports)
- a statement of the reason(s) for requesting a review
What is the Deadline for Requesting a Review?
You may request a review at anytime. Results of requests will be reflected in BlueCompare as quickly as possible; updates are typically made on a daily basis.
How to Opt out of Displaying Your Ribbon until Your Review is Complete
You may opt out of displaying your EBM ribbon information until the review process is complete. If you wish to do so, please submit the form titled "BlueCompare for Physicians-How to Opt Out From Displaying Your Evidence Based Measures (EBM) Information" along with your request for review. The opt out form can be found here.
Where to Direct Other BlueCompare Inquiries
All other inquiries regarding BlueCompare methodology, interpretation of scores, your provider number, tax ID number or specialty designation should be directed to your local Professional Provider Network office. You should receive a response within 30 days of our receipt of the inquiry.
View information on BlueCompare and sample reports for the BlueCompare Evidence Based Measures (EBM).
Please note: General inquiries and requests for reports are not considered by BCBSTX as formal requests for review. Requests for review must follow the procedure outlined above. You do not have to order any reports prior to requesting a review.
Frequently Asked Questions
1. How can I order reports or get a copy of the report(s) from the BlueCompare mailer?
You can request copies of BlueCompare EBM reports.
2. If I ordered reports, will I also get a review?
General inquiries and requests for reports are not considered by BCBSTX as formal requests for review. You do not have to order any reports prior to requesting a review. To ensure your status is reviewed, you must send a written request to your local Professional Provider Network office.
3. Do I need to send a written request for review or can I call my local PPN representative to request a review?
We request that reviews be in writing because a written request enables us to track and forward the case to the correct staff members for a response. They can be mailed, faxed or sent via email to the local Professional Provider Network office. The request should include:
- the date of the request
- your name and address
- your Provider Number
- your Practice Evaluation ID Number (found on the BlueCompare letter and reports)
- a statement of the reason(s) for requesting a review
4. What kind of information should I submit for a review of my EBM information?
You are not required to submit any additional information when requesting a review, but it can be helpful. The following are examples of information that will be considered during the EBM ribbon information review process.
- Medical records for patients that were assessed as part of the Evidence Based Measures designation process.
a. Documentation that target processes were completed or ordered.
b. Documentation that the patient does not fit in the denominator for the measure.
c. Quality improvement reports from an electronic medical record system demonstrating your level of performance.
d. Completed tools, such as data collection flow sheets, located within relevant conditions and measures listed on the AMA Physician Consortium on Performance Improvement Measurement Web site.
- Demonstrate that your practice has a system for delivering preventive and other evidence based services such as:
5. How long does it take to get a decision on the review?
Our goal is to provide a written response with the results of the review within 30 days from our receipt of your request. In some instances, the timeframe will be extended due to the timing of the Second-Level Review Committees’ meeting dates.
6. How long does it take to change BlueCompare information on Provider Finder®?
All reviews submitted will be processed as noted above and changes will be submitted as quickly as possible; updates are typically made on a daily basis.
7. How does my BlueCompare information affect my participation status in the networks?
- BlueChoice: Your participation in the BlueChoice large PPO network is not affected by your BlueCompare information. Therefore, no action is required on your part to continue your participation.
- BlueChoice Solutions: The information used for BlueCompare may impact participation in the smaller BlueChoice Solutions PPO network. If you have any questions regarding participation criteria, please review the information on the BlueChoice Solutions Web page.
If you have questions regarding your participation, please contact your local Professional Provider Network office.
8. What is the difference between the Dark Blue and the Light Blue ribbon?
Currently the dark blue ribbon represents the top 40% within a given specialty. The light blue ribbon represents those below the top 40% and not significantly below the performance of their peers.
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