Highmark Blue Cross Blue Shield West Virginia

Joyce LandersDirector Provider Relations

Confidential and Proprietary

ICD-10 UpdateWith the Oct. 1, 2015 compliance date now past, the benefits of ICD-10 to healthcare, as a whole, can finally be realized. As the Centers for Medicare and Medicaid Services (CMS) stated in their Oct. 1, 2015 ICD-10 Welcome blog, “The change to ICD-10 allows you to capture more details about the health status of your patients and sets the stage for improved patient care and public health surveillance across our country. ICD-10 will help move the nation’s health care system to better, smarter care.”  As we all settle into our new ICD-10 responsibilities please remember a major part of Highmark’s strategic plan has always included you, our valued network providers. In that regard Clinical Coding testing is continuing to be offered throughout December of 2015. Should you want to further enhance your coding skills please take advantage of this testing opportunity by signing up today.  Communication efforts were and are geared toward your transition efforts. And, the ICD-10 Library is available to assist you. Included in the library are: the Tool Kit, FAQ, published communications, and industry leader websites. The library is located on the Provider Resource Center, under the ICD-10/HIPAA link.

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Prepare Now For Highmark West Virginia National Drug Code (NDC) Requirement – Effective November 16, 2015

Highmark West Virginia will require submission of the National Drug Code (NDC) information on all drug claims billed under the medical benefit for all Highmark West Virginia members. (NDC information is the 11 digit NDC+NDC quantity.) Medicaid and many other health insurance carriers already have this requirement in place. While Healthcare Common Procedure Coding System (HCPCS) codes are non-specific and may represent more than one drug product, NDC information is specific to manufacturer, drug dosage, dosage form and package size.

Capturing this additional data will enable Highmark West Virginia to:

• Integrate pharmacy and medical claims to enhance clinical management for our members.

• Collect and analyze more specific drug data to determine appropriateness of utilization. • Distinguish between use of brand and generic drugs.

WHAT PROVIDERS AND THEIR BILLING STAFF NEED TO KNOW

• Reimbursement will continue to be based on the HCPCS codes, not the NDCs.

• Claims without an NDC will be rejected and will need to be resubmitted with the correct information.

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West Virginia Family Health Medicaid

West Virginia Family Health (WVFH) Medicaid This true partnership owned by 22 FQHCs, other provider organizations and Highmark WV, provides Medicaid MCO services. Current Enrollment as of 9-1-15 (52,000) continues to grow.

Expansion to Cabell and Wayne Counties : Letters were mailed on or about 9/28 to membership in those counties.   WVFH Media Marketing in the area in October. 

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WVFH Identification card (TANF)

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WVFH Identification Card - (Expansion)

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WVFH Identification Card (Back) same for both TANF and Exchange members

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West Virginia Medicare Advantage STARS Reaches 4.0 for 2017

 

As the result of a team effort from many areas across the enterprise and the hard work from the providers , the WV Medicare Advantage plan, FreedomBlue, obtained a 4.0 STARS rating.

The positive impact to members from this effort – Thank you to everyone!

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Changes To Professional Fee Schedule

Effective October 1, 2015

Highmark Blue Cross Blue Shield West Virginia continually evaluates its fee schedule to remain fair and competitive. We also strive to ensure our reimbursement supports quality and value for our group customers and our members. Based on this ongoing evaluation, we will update the PPO/POS professional fee schedule, effective with dates of service on/after October 1, 2015.

To continue to support our shared goals of improved quality, total patient management through care coordination and optimized patient experience, Highmark West Virginia will adjust fees for select CPT codes, effective with dates of service on October 1, 2015 and beyond. As with past annual fee schedule reviews, Highmark West Virginia continues to rely on the Centers for Medicare & Medicaid Services (CMS) RBRVS fee schedule as a benchmark in assessing its professional fees. On average, the Highmark West Virginia fee schedule continues to perform higher than the CMS schedule, helping us to keep our valuable provider network strong.

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Highmark Blue Cross Blue Shield West Virginia recently announced new self-service prompts would be added to its existing Provider Service telephone lines.

Beginning October 12, 2015 through October 30, 2015 roll out of this innovative Provider Service telephone system will occur.

Highmark West Virginia is obviously enthusiastic about the new self-service automated options which, we feel, may afford your practice or facility time and resource savings.

Existing Provider Service telephone numbers are NOT changing!

You will continue to call: 1-800-543-7822

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Provider Service Telephone Lines

3-D MAMMOGRAMS ARE ELIGIBLE

Effective Oct. 5, 2015, a directive from the Commonwealth of Pennsylvania requires Highmark members to be covered for 3-D mammograms or breast tomosynthesis when billed as a screening or diagnostic test.

Providers who billed for 3-D mammograms on Oct. 5, 2015, through Oct. 18, 2015, will experience claim denials. Although claims will deny, providers will not need to call member services or send a NaviNet investigation. In the near future, claims with dates of service during this time period will be adjusted.

Note: Highmark's radiology privileging requirements for mammography are still in the process of research and revision. Watch for additional information on Plan Central soon.

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3D Tomosynthesis Mammography

NaviHealth specializes in managing post-acute care services. naviHealth partners with health plans, health systems and post-acute providers to manage the entire continuum of post-acute care. naviHealth health care professionals work with skilled nursing facilities, long term acute care, inpatient rehabilitation and acute care hospitals to maximize post-acute care outcomes for Highmark members. Evidence-based protocols optimize care, resulting in reduced hospital readmissions, increased patient satisfaction and improved patient outcomes.

Watch for more informaiton and details communicated on NaviNet, Highmark WV Provider Resource Center and Provider News.

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Starting 1-1-2016 POST-ACUTE CARE MANAGEMENT FOR Highmark WV Freedom Blue MEDICARE ADVANTAGE MEMBERS