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Blue Cross Blue Shield Alabama Hospital Association Meeting Updates

Stay updated on EAPG transition, radiology precertification changes, preferred medical labs, and more. Verify eligibility and benefits for effective services.

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Blue Cross Blue Shield Alabama Hospital Association Meeting Updates

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Presentation Transcript

  1. Alabama Hospital Association Meeting March 18, 2019 An Independent Licensee of the Blue Cross and Blue Shield Association

  2. Enhanced Ambulatory Patient Grouping Version 3.13 Transition • EAPG transition from version 3.10 to version 3.13, effective 4/1/2019 • EAPG 3.13 Base Rates: Letters of Agreement due March 31, 2019 • EAPG 3.13 National Weight file: Available on ProviderAccess

  3. Outpatient Precertification Requirements • Precertification required for Provider-Administered Drug Program in outpatient hospital setting • Effective for dates of service April 1, 2019, and after • If authorization is not obtained, the facility’s claim may not process appropriately

  4. Preferred Radiology Transition to AIM • Precertification required for the following: • Positron emission tomography (PET) scans; Computerized axial tomography (CT); Computed tomographic angiography (CTA) tests; Magnetic resonance imaging (MRI); Magnetic resonance angiography (MRA) • Precertification is not required for tests ordered during an emergency room treatment visit while in the observation unit or during an inpatient stay • The list of procedure codes that will require precertification via AIM is available on ProviderAccess.

  5. Preferred Medical Labs

  6. Out of Network Providers • Participating hospitals must ensure hospital-based physicians are in-network. • Services provided by out-of-network providers may result in higher member out of pocket costs.

  7. Short Term Limited Duration Plan • Single and family coverage • 6-month or 364-day product available for members • No benefits for pre-existing conditions • Verify benefits to determine eligibility

  8. Eligibility Verification • As of January 1, 2019, Quantum handles customer service, precertification and medical review for Blue Cross and Blue Shield of Alabama group. • Verify eligibility and benefits prior to rendering services.

  9. New Medical and Drug Policies Site

  10. Durable Medical Equipment Complaints • Members are receiving DME that has not been requested. • Educate patients prior to discharge to be aware of phone calls asking if they need DME and accepting equipment not discussed during discharge

  11. Provider Solutions Mailbox

  12. Thank You

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