Quick SummaryQuality Improvement

Case Management -- Assistance to Take Charge of Your Patients’ Health Care Needs

2

Claims and Billing Durable Medical Equipment (DME) and Medical Supplies

3

Updates to the CareFirst BlueChoice In-Office Procedure List

3

Health Care Policy

New Technology Evaluated 4

Medical Policy Updates 5-8

Provider Seminars 9-11What’s Happening

Seminars to Fit All Needs 11

Pharmacy Updates 12Provider Representatives Professional Provider Representatives 13

Phone Numbers & Addresses 14-15

A News Publication Linking CareFirst and CareFirst BlueChoice with Participating Physicians, Providers and Institutions

See Quality Improvement for more information

CareEssentialsBlueLink is part of the Utilization Management component of CareEssentials, our care management program that provides you with essential tools for patient care.

Note: All references to “CareFirst” in this publication refer to CareFirst BlueCross BlueShield. All references to “CareFirst BlueChoice” refer to CareFirst BlueChoice, Inc.

LinkBlue March/April 2010 Vol. 12, Issue 2

Take Charge of Your Patients’ Health Care NeedsCareFirst’s Case Management services can enhance your patients’ overall care by providing an organized, comprehensive and holistic approach to their health care needs.

� BLUELink March/April 2010 u Vol. 12, Issue 2

Quality Improvement

Case Management -- Assistance to Take Charge of Your Patients’ Health Care Needs

areFirst’s Case Management services can enhance your patients’ overall care by providing an organized, comprehensive and holistic approach to their health care needs. These services will reduce the frustration

of fragmented care that those with complex care requirements often face. The Case Manager can help navigate the complex health care maze by coordinating medical care services and help patients better understand what is happening to their health. Our specialty programs include:

Generalist – Our generalist case management team is comprised of registered nurses with diverse clinical backgrounds for patients with acute and chronic disease processes.

Pediatrics - Our pediatric case managers are experienced pediatric clinicians. They manage referrals for children ages 0 to 17 years with simple to complex health care needs. Our pediatric program also includes oncology education and support.

Oncology – Our oncology case management team is comprised of registered nurses with oncology experience and expertise to assist patients with a cancer diagnosis.

Great Beginnings – A case manager will contact the member during each trimester of their pregnancy to provide supplemental support for expectant mothers, family members and physicians to enhance optimal maternal-infant outcomes.

Case Management Program GoalsThe patient’s welfare is always our first concern. The Case Manager will always work to:n Contribute to patients’ sense of well-being and dignityn Enhance the quality of life for your patients and their

familiesn Positively influence the quality of health caren Improve health, restore function and prevent disabilityn Reduce the negative effects of a serious, chronic or terminal

health conditionn Increase customer satisfactionn Empower patients and their family members through

education and available resources

When your patients enroll in the Case Management program, a Case Manager will contact them to review their medical history and identify important factors that may affect their health.

The Case Manager is available to answer questions from 8 a.m. to 4:30 p.m. Monday through Friday. Members/patients have the added convenience of making a self referral into our Case Management programs by enrolling online at www.carefirst.com > Members and Visitors > Solutions Center > Care Essentials > Case Management. To find out more information about our programs, please call 888-264-8648.

CareFirst and CareFirst BlueChoice offer Great Beginnings, a comprehensive program in which Case Management nurses provide on-going support and valuable health information to women during pregnancy. This coordination of care with the member’s physician helps to reduce the level of stress for expectant mothers.

Case managers work with the physician to coordinate an effective treatment plan based on the individual needs of the member, as well as identify obstacles affecting compliance to care. If the member has complications during pregnancy, the Case Manager will work closely with the doctor to coordinate necessary services.

Practitioners may refer a member to the Great Beginnings program by calling 888-264-8648 or sending the member’s name, ID number and estimated date of delivery to a secure Rightfax # 410-720-5829. Members/patients may self-refer into our Case Management programs by enrolling online at www.carefirst.com/greatbeginnings.

Many other Blue Cross and Blue Shield plans offer similar programs to their members and the programs vary by plan. Please let your out-of-area patients know that such a program might be available to them and they should contact their home plan for additional information.

C

� BLUELink March/April 2010 u Vol. 12, Issue 2

Claims and Billing

eminder: When billing monthly rentals for DME using Healthcare Common Procedure Coding System (HCPCS) codes, the appropriate unit to report is one (1) month for

rental of equipment, unless the specific HCPCS code description states daily.

When billing HCPCS code A4259:Lancets, the appropriate unit to report is one (1) per box of 100.

When billing HCPCS code A4253: Blood Glucose test or reagent strips for home blood glucose monitor, the appropriate unit to report is one (1) per 50 strips.

Durable Medical Equipment (DME) and Medical Supplies

R

or claims processed on and after Jan. 1, 2010, the following radiology services can be performed in a physician office setting (in addition to contracted radiology facilities). Be sure to verify member eligibility and coverage prior to rendering services, as benefit limitations and medical policy requirements still apply.

A complete list of in-office codes is located in the Benefits section of the CareFirst BlueChoice Provider Manual. To access the manual online, access www.carefirst.com > Providers & Physicians > Provider Manuals in the Solution Center.

CareFirst and CareFirst BlueChoice expect all providers who perform laboratory or imaging tests at any site to obtain and/or maintain the appropriate federal, state and local licenses and certifications; training; quality controls; and safety standards

pertinent to the tests performed.

Updates to the CareFirst BlueChoice in-Office Procedure List

FProcedure Code Specialty

75791 Nephrology

75791 All PCPs and Specialists

78451 7845278453 78454

Cardiology

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Health Care Policy

New Technology Evaluatedur Technology Assessment Unit evaluates new and existing technologies to apply to our local indemnity and managed care benefit plans. The unit relies on current scientific evidence published in peer-reviewed medical literature, local expert consultants and physicians to determine whether

those technologies meet CareFirst and CareFirst BlueChoice criteria for coverage. Policies for non-local accounts like NASCO and FEP may differ from our local determinations. Please verify member eligibility and benefits prior to rendering services via BlueLine, FirstLine or CareFirst Direct.

The Technology Assessment Unit recently made the following determinations:

*Note: Current Procedural Terminology (CPT®) codes and descriptions only are copyright of the 1966 American Medical Association. All rights reserved.

O

Technology Description CareFirst and CareFirst Blue Choice Determination

Endoscopic radiofrequency thermal ablation of Barrett’s esophagus (“HALO” procedure)

Endoscopic thermal ablation system to remove metaplasia associated with development of esophageal carcinoma

Considered medically necessary

CPT® reporting code 43499

Transanal endoscopic microsurgery (TEM)

Uses a proprietary endoscopic system for excision of benign or malignant tumors of the rectum

Considered medically necessary for benign or low-risk T1 malignant tumors

Considered experimental/ investiga-tional for high-risk or higher grade (T2 or higher) malignant tumors

CPT® reporting code 0184T

Percutaneous lumbar discectomy

Uses a percuta-neous approach with fluoroscopic guidance and pro-prietary probes to remove interverte-bral disc material

Considered experimental/ investigational

CPT® reporting code 62287

Radiofrequency ablation of inoper-able malignant tumors of the lung

Uses radiofrequen-cy thermal energy to destroy tumors where resection is not feasible

Considered experimental/ investigational

CPT® reporting code 32998

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Health Care Policy

Medical Policy Updates ur Health Care Policy department continually reviews medical policies and operating procedures as new, evidence-based information becomes available regarding advances in new or emerging technologies, as well as current technologies, procedures and services.

The table below is a guide designed to provide updates on any changes to existing or new local policies and procedures during our review process. Each local policy or procedure listed includes a brief description of its status, select reporting instructions and effective dates. Policies for non-local accounts, such as NASCO and FEP, may differ from our local determinations. Please verify member eligibility and benefits prior to rendering services via BlueLine, FirstLine or CareFirst Direct.

* Note: The effective dates for the policies listed below mean claims processed on and after that date.

O

MeDICAl PolICy ACTIoNS, CoMMeNTS AND PolICy STATUS AND AND/oR PRoCeDURe RePoRTINg gUIDelINeS eFFeCTIVe DATe

1.01.015AAugmentative Communication Devices

1.01.019AAir Cleaner/Purifier

1.01.025ACervical Pillow

1.01.030Dynamic Splinting Systems

1.01.035ALumbar Roll Cushion

No further review

scheduled.

Effective 1/19/2010

No further review

scheduled.

Effective 3/15/2010

No further review

scheduled.

Effective 3/15/2010

Periodic review and

update.

Effective 3/15/2010

No further review

scheduled.

Effective 3/15/2010

Operating Procedure remains unchanged. Report services with the

appropriate CPT® codes 92506, 92507, 92508, 92606, 92607,

92608 or 92609. Report devices with HCPCS codes E1902, E2500,

E2502, E2504, E2506, E2508, E2510, E2511, E2512 or V5336.

Operating Procedure unchanged.

Benefits are not provided for air cleaner/purifiers as they

are considered environmental control equipment and can be

purchased over-the-counter. Report with HCPCS code E1399.

Operating Procedure unchanged. Benefits are not provided for

cervical pillows as they are considered for comfort or convenience,

not primarily medical in nature and can be purchased over-the-

counter. Report with HCPCS code E0190.

Under Policy Guidelines added an updated 2010 rationale

statement. Medically necessary, not medically necessary and

experimental/ investigational indications remain the same. For

dynamic splinting systems report with HCPCS codes E1800, E1802,

E1805, E1810, E1812, E1815, E1820, E1825, E1830 or E1840. Report

HCPCS code E1399 for the Carpal Tunnel Dynasplint® system.

Operating Procedure unchanged. Benefits are not provided

for lumbar roll cushions as they are considered for comfort

or convenience, not primarily medical in nature and can be

purchased over-the-counter. Report with HCPCS code E0190.

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Health Care Policy

Medical Policy Updates

MeDICAl PolICy ACTIoNS, CoMMeNTS AND PolICy STATUS AND/oR PRoCeDURe RePoRTINg gUIDelINeS AND eFFeCTIVe DATe

Operating Procedure unchanged. Benefits are not provided for massage devices

as these are considered personal comfort items, not primarily medical in nature

and can be purchased over-the-counter. Report with HCPCS code E1399.

Under Policy Guidelines added an updated 2009 rationale statement. Medically

necessary and experimental/ investigational indications remain the same. Report

with HCPCS code S0157.

Under Policy Guidelines added an updated 2010 rationale statement.

Biofeedback remains experimental/ investigational. Report individual

psychophysiological therapy incorporating biofeedback training with CPT®

codes 90875 or 90876. Report biofeedback training with CPT® codes 90901 or

90911. Report the biofeedback device with HCPCS code E0746.

Under Benefit Applications, statement revised to read, “Additional benefits are

not provided for total body photography, regardless of the individual performing

the photography, as it is considered a form of medical documentation, and is

therefore included in the benefit for office evaluation and management.” Report

with CPT® code 96904.

Under Policy Guidelines added an updated 2010 rationale statement.

Quantitative Sensory testing remains experimental/ investigational. Report with

CPT® Category III codes 0106T, 0107T, 0108T, 0109T or 0110T.

Under Policy Guidelines added an updated 2009 rationale statement. Medically

necessary and not medically necessary indications remain the same. Report with

CPT® code 92971.

Under Policy Guidelines added an updated 2009 rationale statement.

Transcatheter hepatic arterial chemoembolization is considered medically

necessary for the following indications:

• the treatment of unresectable primary hepatocellular carcinoma; or

• unresectable metastatic hepatic tumors in patients who have failed

conventional treatment; or

• in patients who are not otherwise candidates for conventional systemic

chemotherapy; or

• as a bridge to transplant to maintain a patient’s candidacy.

All other indications are considered experimental/ investigational. Report with

CPT® codes 37204 and 75894.

Under Policy Guidelines added an updated 2010 rationale statement. Medically

necessary indications remain the same. Report with appropriate Category I

CPT® code.

No further review

scheduled.

Effective 3/15/2010

Periodic review and

update.

Effective 2/22/2010

Periodic review and

update.

Effective 3/15/2010

Periodic review and

update.

Effective 1/19/2010

Periodic review and

update.

Effective 3/15/10

Periodic review and

update.

Effective 1/19/10

Periodic review and

update.

Effective 1/19/2010

Periodic review and

update.

Effective 3/15/2010

1.01.036AMassage Devices

2.01.016Blood-Derived Growth Factors for Wound Healing

2.01.035Biofeedback

2.01.054ATotal Body Photography for Melanoma Risk Monitoring

2.01.059Quantitative Sensory Testing for Peripheral Neuropathies

2.02.001External/ Extracorporeal Counterpulsation (ECP or EECP)

2.03.003Transcatheter Arterial Chemoembolization for Malignant Tumors of the Liver

3.01.009Attention Deficit Disorder (ADD) with or without Hyperactivity

� BLUELink March/April 2010 u Vol. 12, Issue 2

Health Care Policy

Medical Policy Updates

MeDICAl PolICy ACTIoNS, CoMMeNTS AND PolICy STATUS AND/oR PRoCeDURe RePoRTINg gUIDelINeS AND eFFeCTIVe DATe

Description updated to include storage of embryo(s), sperm/semen, and

testicular tissue. Report the appropriate Category I CPT® codes for related

assisted reproductive technology procedures and laboratory procedures.

Under Policy Guidelines added an updated 2010 rationale statement. Medically

necessary, experimental/ investigational and cosmetic indications remain the

same. Report with appropriate Category I CPT® code.

Description updated to reference the FDA approval of Gardasil for males age

9 through 26. Under the Policy statement, Gardasil® was updated to include

the medically necessary preventive service for males age 9 through 26. Also

added bivalent human papillomavirus (Types 16 and 18) recombinant vaccine

(e.g., Cervarix®) as a medically necessary preventive service for females, ages

10 through 25 years of age. Bivalent human papillomavirus (HPV) vaccine

for all other indications is considered experimental/ investigational. Under

Policy Guidelines added an updated 2009 rationale statement. Under Benefits

Applications, clarified, “when benefits are provided in the member’s contract,

benefits are provided for three scheduled doses of Quadrivalent human

papillomavirus (Types 6,11,16, 18) recombinant vaccine (e.g. Gardasil) for females

and males aged 9 through 26 or bivalent human papillomavirus (Types 16,

18) recombinant vaccine (e.g., Cervarix®) for females ages 10 through 25. If a

member receives the first three scheduled doses by age 26 for quadrivalent HPV

vaccine or by 25 for bivalent HPV vaccine, benefits are provided for the second

and third doses. Under Provider Guidelines added the 2009 ACIP provisional

HPV vaccine recommendations for females and males; as well as the provisional

recommendations for administration, precautions and contraindications. Report

the quadrivalent HPV vaccine with CPT® code 90649 and the bivalent HPV

vaccine with CPT® code 90650.

Magnetoencephalography/magnetic source imaging was changed from

experimental/ investigational to medically necessary for the purpose of

determining laterality of language function as a substitute for the Wada test

in patients being prepared for surgery for epilepsy, brain tumors, and other

indications requiring brain resection. Magnetoencephalography/magnetic source

imaging for all other indications is considered experimental/investigational.

Under Policy Guidelines added an updated 2009 rationale statement. Report

with CPT® codes 95965, 95966 or 95967.

Under Policy statement, revised medically necessary statement to read

“Cochlear implantation, with an FDA approved single or multi-channel cochlear

implant, and associated aural rehabilitation is considered medically necessary

in patients with severe to profound sensorineural deafness who cannot benefit

from a hearing aid. Cochlear implantation for all other indications is considered

not medically necessary.” Under Policy Guidelines added an updated 2010

rationale statement. Report with appropriate Category 1 CPT® code.

Policy revision.

Effective 2/22/2010

Periodic review and

update.

Effective 3/15/2010

Periodic review and

update.

Effective 2/22/2010

Periodic review and

update.

Effective 2/22/2010

Periodic review and

update.

Effective 3/15/2010

4.02.001Assisted Reproductive Technology (ART) Procedures: In Vitro (IVF) Gamete Intrafallopian Transfer (GIFT) Zygote Intrafallopian Transfer (ZIFT)

5.01.005Botulinum Toxin

5.01.017Human Papillomavirus (HPV) Recombinant Vaccines (quadrivalent and bivalent)

6.01.036Magnetoencephalography and Magnetic Source Imaging

7.01.005Cochlear Implantation

� BLUELink March/April 2010 u Vol. 12, Issue 2

Health Care Policy

Medical Policy Updates

MeDICAl PolICy ACTIoNS, CoMMeNTS AND PolICy STATUS AND/oR PRoCeDURe RePoRTINg gUIDelINeS AND eFFeCTIVe DATe

Within attached table, added subcategory “Sculptra®” with cosmetic and

reconstructive indications.

Under Policy Guidelines added an updated 2010 rationale statement. The

cavernous nerve stimulation device remains experimental/ investigational.

Report with CPT® code 95999.

Changed from a medical policy to an operating procedure. Under Benefit

Applications added, “Separate benefits are not provided for computer assisted

navigation as it is considered included in the orthopedic joint replacement

procedure.” Report with CPT® codes +20985, 0054T or 0055T.

Total vertebral disc replacement with an FDA-approved lumbar disc prosthesis

changed from experimental/ investigational to medically necessary for patients

who meet all of the following criteria:

• Are skeletally mature;

• Have degenerative disc disease at only one level in the lumbar spine

from L4-S1;

• Have no more than 3 mm of spondylolisthesis at the involved level;

• Have had no relief from pain after at least six months of non-surgical

treatment.

Vertebral disc replacement at more than one level or in patients who do not

meet the above criteria is considered experimental/investigational. Under

Policy Guidelines added an updated 2009 rationale statement. Under Provider

Guidelines contraindications to total lumbar vertebral disc replacement noted.

See policy for details. Report with CPT® codes 22857, 22862 or 22865.

Under Policy Guidelines added an updated 2009 rationale statement.

Cervical intervertebral disc replacement remains experimental/ investigational.

Report with CPT® codes 22856, 22861, 22864, +0092T, +0095T or +0098T.

Under Policy Guidelines added an updated 2009 rationale statement. Bronchial

thermoplasty for control of asthma remains experimental/ investigational.

Report with CPT® code 31899.

Under Policy Guidelines added an updated 2009 rationale statement. Genetic

testing for Canavan disease to determine carrier status remains medically

necessary. Report with CPT® codes with modifier 83890-5A – 83914 – 5A.

Under Policy Guidelines added an updated 2009 rationale statement. Serum

biomarker panels for assessment of liver fibrosis remain experimental/

investigational. Report with unlisted CPT® code 84999.

Periodic review and

update.

Effective 2/22/2010

Periodic review and

update.

Effective 3/15/2010

Periodic review and

update.

Effective 2/22/2010

Periodic review and

update.

Effective 2/22/2010

Periodic review and

update.

Effective 1/19/2010

Periodic review and

update.

Effective 2/22/2010

No further review

scheduled.

Effective 1/19/2010

Periodic review and

update.

Effective 1/19/2010

7.01.017Cosmetic and Reconstructive Surgery with Attached Companion Table

7.01.040Cavernous Nerve Stimulation Device

7.01.050AComputer Assisted Navigational Techniques in Orthopedic Surgery

7.01.088Vertebral Disc Replacement/ Lumbar Disc Prosthesis

7.01.100Cervical Vertebral Disc Replacement

7.01.102Bronchial Thermoplasty for Control of Asthma

11.01.027Genetic Testing for Canavan Disease

11.01.037Serum Biomarker Panels for Assessment of Hepatic Fibrosis

* Note: Current Procedural Terminology (CPT®) codes and descriptions only are copyright of the 1966 American Medical Association. All rights reserved.

� BLUELink March/April 2010 u Vol. 12, Issue 2

Provider Seminars

Practitioner and Staff Seminars and Training Sessions

C areFirst and CareFirst BlueChoice offer half-day seminars and webinars designed to familiarize professional and institutional providers and office staff with CareFirst and CareFirst BlueChoice policy, provider-oriented procedures and tools. The types of seminars and webinars are listed below accompanied by a brief description and its identification code to assist in selecting the presentations that best meet your needs.

Professional SeminarsBasics & Updates – designed as a new provider staff employee training tool or a refresher for a seasoned employee. This seminar will review CareFirst prod-ucts, referrals, authorizations, COB and much more. The seminar will conclude with a CareFirst update and questions and answers.

Specific Specialty – designed to inform and update specific specialty providers. New Date

Date and Time location Room

Tuesday, March 23, 201010 a.m. to 1 p.m.Basics & Updates

Holiday Inn Express241 Railway LaneHagerstown, Md. 21740

Conference Room

Thursday, April 8, 201010 a.m. to 1 p.m.Basics & Updates

CF Owings Mills10455 Mill Run CircleOwings Mills, Md. 21117

MPR LL-03

Wednesday, April 14, 20101 p.m. to 4 p.m.Basics & Updates

Mount Vernon Hospital2501 Parker’s LaneAlexandria, Va. 22306

Engh CC

Tuesday, April 20, 201010 a.m. to 1 p.m.Basics & Updates

Mercy Hospital227 St. Paul Place 2nd FlrBaltimore, Md. 21212

Truman Seman

Wednesday, April 28, 201010 a.m. to 1 p.m.Basics & Updates

CF Union Center Plaza840 First Street N.E.Washington, D.C. 20065

Room 10081

Tuesday, May 4, 201010 a.m. to 1 p.m.Basics & Updates

Hampton Inn5311 Buckeystown PikeFrederick, Md. 21704

Catocin

Friday, May 14, 20108:30 a.m. to noonBasics & Updates

Howard County Gen. Hosp.Medical Pavillion at Howard County General10710 Charter DriveColumbia, Md. 21044

Rockbury Mill Room

Tuesday, May 18, 201010 a.m. to 1 p.m.Basics & Updates

Carroll County Medical Ctr.200 Memorial Ave.Westminster, Md. 21157

Learning Center

10 BLUELink March/April 2010 u Vol. 12, Issue 2

Provider SeminarsPractitioner and Staff Seminars and Training Sessions (continued)

Ancillary – Regional Ancillary Semi-nars – dialysis, skilled nursing facility (SnF), durable medical equipment (DME), home infusion therapy (HiT), ambulatory surgical center (ASC), hos-pice, home health (HH) and substance abuse and mental health (Sub/Mtl).

Ancillary Seminars

Hospital Quarterly – designed for hospital office staff to receive updated CareFirst information.

Hospital SeminarsDate and Time location Room

Tuesday, April 27, 20101 p.m. to 4 p.m.Hospital Quarterly

Providence Hospital1150 Varnun St. N.E.Washington, D.C. 20017

Ross Auditorium

Tuesday, May 11, 201010 a.m. to 1 p.m.Hospital Quarterly

Baltimore Washington Hospital305 Hospital DriveGlen Burnie, Md. 21061

Tate – Lower Level Courtney Conference

Thursday, May 20, 201010 a.m. to 1 p.m.Hospital Quarterly

Hampton Inn – Salisbury121 East Naylor Mill RoadSalisbury, Md. 21804

Chesapeake Room

Tuesday, May 25, 201010 a.m. to 1 p.m.DRg Training

Virginia Hospital Center1701 N. George Mason DriveArlington, Va. 22205

John T. Hazel Conference Center

Date and Time location Room

Thursday, March 25, 201011 a.m. to 1 p.m.HIT

CF Owings Mills10455 Mill Run CircleOwings Mills, Md. 21117

MPR-LL03

Wednesday, April 7, 201010 a.m. to 1 p.m.ASC

Holy Cross Hospital1500 Forest Glen RoadSilver Spring, Md. 20910

B&D

Thursday, April 15, 201010 a.m. to 1 p.m.Hospice

CF Owings Mills10455 Mill Run CircleOwings Mills, Md. 21117

MPR LL-03

Wednesday, April 21, 2010Noon to 4 p.m.Sub/Mtl

Mount Vernon Hospital2501 Parker’s LaneAlexandria, Va. 22306

Engh CC

Tuesday, April, 27, 201010 a.m. to 1 pm.SNF

The Krystal Q Conference9630 Technology DriveEaston, Md. 21601

Conference Room

Wednesday, May 12, 201010 a.m. to 1 p.m.DMe

Shady Grove Adventist Hosp.9901 Medical Center DriveRockville, Md. 20850

Sycamore Room

Wednesday, May 26, 20101 p.m. to 4 p.m.DMe

Franklin Square Hospital 9000 Franklin Square DriveBaltimore, Md. 21237

Room F

11 BLUELink March/April 2010 u Vol. 12, Issue 2

Provider SeminarsPractitioner and Staff Seminars and Training Sessions (continued)

Webinars

To register for any of these seminars, Webinars or training sessions, visit the Providers & Physicians section of www.carefirst.com for a full list of 2010’s most recently updated seminars, Webinars and training sessions and select Register for a Seminar in the Solution Center. If you do not have Internet access, call the Provider Seminar Registration Line at 877-269-2219. Please note: Sign in for seminars 15 minutes prior to the scheduled start time.

Webinar -- A Web-based training designed to present CareFirst and CareFirst BlueChoice policies and procedures to professional and institutional providers. These Webinars last �0 minutes, but participants should allow for log on and in-structional time. After enrolling, you will receive instructions �� hours prior to the presentation date via email. Webinars are CareFirst Quality Rewards qualified Web-based office staff training modules.

DATe ToPIC Time

April 6, 2010 OB/GYN 10 a.m.

April 6, 2010 Sub/Mtl-Institutional 12:30 p.m.

April 14, 2010 ASC 12:30 p.m.

April 14, 2010 MPOS 2 p.m.

April 22, 2010 SNF 12:30 p.m.

April 22, 2010 BlueChoice 2 p.m.

April 27, 2010 CDH 10 a.m.

April 27, 2010 HIT 12:30 p.m.

May 5, 2010 Dialysis 12:30 p.m.

May 5, 2010 Anesthesia 2 p.m.

May 13, 2010 OB/GYN 10 a.m.

DATe ToPIC Time

May 13, 2010 Hospice 12:30 p.m.

May 18, 2010 PT/OT/ST/Chiro 10 a.m.

May 18, 2010 DME 12:30 p.m.

May 26, 2010 BlueChoice 10 a.m.

May 26, 2010 Home Health 12:30 p.m.

June 10, 2010 Anesthesia 10 a.m.

June 10, 2010 ASC 12:30 p.m.

June 15, 2010 Sub/Mtl-Institutional 12:30 p.m.

June 15, 2010 MPOS 2 p.m.

June 23, 2010 CDH 10 a.m.

June 23, 2010 SNF 12:30 p.m.

he CareFirst Provider Education and Training team offers a variety of training opportunities for our institutional, ancillary and professional providers. If

you wish to learn more about the CareFirst basics, the “Basics and Updates” seminar is what you need. If you have attended “Basics and Updates” and need information specific to your provider type, one of our web-based seminars, designed specifically toward various provider types, will provide the information and updates that you require.

To access the most up-to-date training schedule, go to the Providers & Physicians section of the CareFirst Web site at www.carefirst.com. In addition to training schedules, you may also access The Center for Provider Education & Training. The Center offers a variety of self-paced training modules that you may complete at your convenience. We are always seeking your feedback, so please be sure to complete the evaluation.

Seminars to Fit All needs

T

What’s Happening

1� BLUELink March/April 2010 u Vol. 12, Issue 2

Pharmacy Updates

Prior Authorizations/Quantity Limits

New GenericsThe following drugs will be available as generic. The generics will be covered on tier 1 and the brand-name drugs will move to tier 3 or non-preferred.

The following drugs now have generic equivalents. The generics are available as tier 1 and the brand-name drugs remains on tier 3 or non-preferred.

For the most current preferred drug list, prior authorization forms and pharmaceutical management procedures, visit www.carefirst.com > Providers & Physicians > Prescription Drugs. For a paper copy of the formulary and pharmaceutical management procedures, call 877-800-3086.

Drug Quantity limit

Sumavel™ Dosepro™ 8 injections per 34 days

Quantity Limits

Brand name generic

Pulmicort respules® budesonide inhalation suspension

Brand name generic

Loprox® shampoo ciclopirox

Mirapex® pramipexole

1� BLUELink March/April 2010 u Vol. 12, Issue 2

Provider Representatives

Find Your Institutional Provider Representativesot sure who your Institutional provider representative is or what number to call to reach him or her? See the chart below to find out. This information, as well as professional provider information, can be found in the Providers & Physicians section of www.carefirst.com by clicking on Professional or Institutional under Find My Provider Representative.n

Ancillary Provider Assignments

Hospital Assignments

Joanna Clark

Carol Kreigh

Mike Rutkowski

Dena Whitener

Dottie Humes

Baltimore, Cecil and Harford counties and Baltimore City Caroline, Dorchester, Kent, Queen Anne’s, Somerset, Talbot, Wicomico and Worcester counties

Calvert, Charles, Montgomery, Prince George’s and St, Mary’s counties and Washington, D.C. and Virginia

Allegany, Carroll, Frederick, Garrett, Howard and Washington counties and Pennsylvania and West Virginia

Anne Arundel and Baltimore counties, Baltimore City, Washington, D.C., Virginia, and all Home Infusion Therapy Providers

Representative Name Telephone Service Area

410-872-3572

410-763-6353

410-872-3539

410-872-3816

410-872-3575

Representative Name Telephone Hospital Name

Donna Brohawn

Amy Meister

Carol Kreigh

Chris Hudnall

Darin Hutchins

410-872-3571

410-872-3573

410-763-6353

410-872-3536

410-872-3537

* AA Medical Center * Frederick Memorial * Harford Memorial Hospital * Johns Hopkins * Kennedy Krieger* Mercy Medical Center

* Mem Hosp, Cumberland* Garrett County Memorial * Howard County General* Hopkins Bayview Medical Center* St. Agnes Hospital

* Upper Chesapeake Medical* Washington County Hospital* WMHS Braddock Hospital* Veteran’s Affairs Med. Center

* Baltimore Washington Medical Center* Bon Secours Hospital * Civista Medical Center * Calvert Memorial Hospital * Carroll Hospital Center * Franklin Square Hospital

* Georgetown Hospital* Good Samaritan Hospital * Greater Baltimore Medical* Harbor Hospital Center * Kernan Hospital* Levindale Hospital* Maryland General Hospital

* Mt. Washington Pediatric * Northwest Hospital* Sheppard Pratt* Sinai Hospital * St. Mary’s Hospital Center* Union Memorial * U of MD Medical Center

* Dorchester General Hospital * Chesapeake Rehab * Union Hosp. of Cecil Cty

* Atlantic General * Memorial Hospital at Easton * McCready Memorial

* Peninsula Regional Medical Center * Chester River Hospital

* Inova Alexandria Hospital * Loudoun Hospital Center * Virginia Hospital Center * Mary Washington * Children’s Hosptial * Inova Mt. Vernon * Dominion Hospital

* Potomac Hospital* Inova Fairfax Hospital * Prince William Hospital* Fair Oaks Hospital * Providence Hospital* Faquier Hospital * Psychiatric Institute of Washington

* Ft. Washington Medical Center * Reston Hospital Center* George Washington Hospital * Northern Virginia Community* Veteran’s Affairs * Hospital for Sick Children* United Medical Center

* Doctor’s Community Hospital * Sibley Memorial Hospital * Southern Maryland Hospital Center* St. Joseph Medical Center* Holy Cross Hospital * Suburban Hospital

* Washington Adventist* Howard University Hospital * Washington Hospital Center* Laurel Regional Hospital * Walter Reed Hospital * Montgomery General Hospital * National Naval Medical

* National Rehabilitation Center * Malcolm Grow Medical * Potomac Ridge * DeWitt Army Hospital * Prince George’s Hospital Center * St. Elizabeth Hospital* Shady Grove Adventist Hospital

1� BLUELink March/April 2010 u Vol. 12, Issue 2

Important Phone Numbers and Addresses

March 1, 2010: Here is a list of the CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. service areas that handle Maryland and National Capital Area provider inquiries. Please copy for future reference. Information that has been added or changed since this page last appeared (January/February 2010) is printed in purple font.

PRoVIDeR SeRVICeS NASCo PRoVIDeR SeRVICeS

MD inDEMniTY – XW PREFiX AnD BLUECARD® CLAiMS 410-581-3581 / 800-437-2332

Claims (including oral surgery): Mail Administrator, P.O. Box 14115, Lexington, Ky. 40512-4115

Correspondence: Mail Administrator, P.O. Box 14114, Lexington, Ky. 40512-4114

Mental Health for Level III and Key Groups only 410-581-3581 / 800-437-2332

Claims: Mail Administrator, P.O. Box 14117, Lexington, Ky. 40512-4117

nCA inDEMniTY – XiA, XiJ AnD XWY PREFiXES AnD BLUECARD® CLAiMS CAREFiRST BLUECHOiCE – XiC, Xik AnD XWR PREFiXES BLUEPREFERRED –XiP, XiL AnD XWV PREFiXES BLUECHOiCE ADVAnTAGE – XiH PREFiX BLUE PRECiSiOn – BLUE PRECiSiOn LOGO On iD CARD MHiP - MHiP LOGO On iD CARD 202-479-6560 / 800-842-5975

Claims: Mail Administrator, P.O. Box 14116, Lexington, Ky. 40512-4116

Correspondence: Mail Administrator, P.O. Box 14114, Lexington, Ky. 40512-4114

Provider Services 1-877-228-7268 Claims Submission Mail Administrator P.O. Box 14115, Lexington, Ky. 40512-4115 Correspondence Mail Administrator P.O. Box 14114, Lexington, Ky. 40512-4114

nASCO – nATiOnAL ACCOUnTS SERViCE AnD CLAiMS OPERATiOnS Northrop Grumman - NRG Prefix 877-228-7268 for claims information 800-972-8088 for benefit information Northrop Grumman - ESS or NGC Prefix 800-516-1269 All Other NASCO Accounts, including Consumer Directed Health (CDH) Plans and BlueChoice (excluding XIC prefix) 877-228-7268 Claims: Mail Administrator, P.O. Box 14115, Lexington, Ky. 40512-4115 Correspondence: Mail Administrator, P.O. Box 14114, Lexington, Ky. 40512-4114 FEP – FEDERAL EMPLOYEE PROGRAM – R PREFiX Professional and Institutional providers in Montgomery & Prince George’s counties, Washington, DC and Northern Virginia (east of Rt. 123*) 202-488-4900 Claims: Mail Administrator, P.O. Box 14113, Lexington, Ky. 40512-4113 Correspondence: Mail Admnistrator, P.O. Box 14112, Lexington, Ky. 40512-4112 *For providers west of Rt. 123, send all claims and correspondence to local plan.

ALL OTHER MD FEP PROViDERS Professional 410-581-3568 / 800-854-5256 Institutional 410-581-3567 / 800-321-2580 Claims: Mail Administrator, P.O. Box 14113 , Lexington, Ky. 40512-4113 Correspondence: Mail Administrator, P.O. Box 14111, Lexington, Ky. 40512-4111

FeP PRoVIDeR SeRVICeS

STATe oF MARylAND — All PRoDUCTS

1� BLUELink March/April 2010 u Vol. 12, Issue 2

Important Phone Numbers and Addresses

PRoVIDeR CoNTACTS

BLUECARD® 800-676-BLUE (2583) for eligibility

PROViDER inFORMATiOn AnD CREDEnTiALinG 410-872-3500 / 877-269-9593 Fax: 410-872-4107 / 866-452-2304

Correspondence: CareFirst BlueCross BlueShield, 10455 Mill Run Circle, P.O. Box 825, Mailstop CG-41, Owings Mills, Md. 21117-0825

PROViDER RELATiOnS & PROFESSiOnAL COnTRACTinG 410-872-3500 / 877-269-9593 Fax: 410-505-6900 / 866-452-2306

Correspondence: CareFirst BlueCross BlueShield, 10455 Mill Run Circle, P.O. Box 825, Mailstop CG-52, Owings Mills, Md. 21117-0825

inSTiTUTiOnAL AnD VEnDOR COnTRACTinG 410-872-3500 / 877-269-9593 Fax: 410-872-4106 / 866-452-2305

Correspondence: CareFirst BlueCross BlueShield, 10455 Mill Run Circle, P.O. Box 825, Mailstop CG-51, Owings Mills, Md. 21117-0825

PROViDER SEMinAR REGiSTRATiOn Professional, hospital and ancillary seminar registration 877-269-2219

CARE MAnAGEMEnT Authorizations 866-PRE-AUTH (773-2884) Fax for authorization: 410-528-7027

Case Management 410-605-2413 / 888-264-8648

Correspondence: CareFirst BlueCross BlueShield, Care Management, 1501 S. Clinton St., Mailstop CT-0816, Baltimore, Md. 21224

AUToMATeD VoICe ReSPoNSe UNITS

BLUELinE MD Region – Authorizations, eligibility and claim and benefit inquiry for PPO, MPOS, PPN and MD Indemnity 410-581-3535 / 800-248-8410

FiRSTLinE NCA Region – Eligibility, claim and benefit inquiry for CareFirst BlueChoice, BluePreferred and NCA Indemnity 202-479-6560 / 800-842-5975

FEP – Eligibility, claim and benefit inquiry 202-488-4900

MARYLAnD POinT OF SERViCE (MPOS) REFERRAL FAX LinE Fax for referrals: 410-998-5741

VeNDoR CoNTACTS ARGUS Pharmacy benefits manager 800-314-2872 for prior authorization requests Fax: 800-315-4025

iCORE HEALTHCARE Supplier of injectable drugs 866-522-2470

LABORATORY CORPORATiOn OF AMERiCA (LABCORP) Contracted vendor for CareFirst BlueChoice members 800-322-3629

MAGELLAn HEALTH SERViCES Inpatient & outpatient mental health & substance abuse services 800-245-7013

MEDMARk, inC. Supplier of injectable drugs 888-347-3416

ELECTROniC CLAiMS Emdeon 800-845-6592 GatewayEdi 804-323-0275 MedAvant (formerly ProxyMed) 800-792-5256, ext. 813 MTrans (Misys) 800-347-3473, ext.2188 Payerpath 877-623-5706, ext. 2 RealMed 877-927-8000 RelayHealth • Institutional 800-693-6890 • Professional 847-608-7000 ProtoMed 800-648-4836

DiSEASE MAnAGEMEnT To refer patients to a program call: Asthma/COPD 800-323-4472 Diabetes and Heart Disease 800-783-4582 Oncology 888-264-8648

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.

1� BLUELink March/April 2010 u Vol. 12, Issue 2

CHIEF MEDICAL OFFICER AND SR. VICE PRESIDENT OF MEDICAL AFFAIRS EDITOR Jon P. Shematek M.D. Robert Hilson newsletter.editor@carefirst.com

BlueLink is published bimonthly by CareFirst BlueCross BlueShield’s Corporate Communications Department.

10455 Mill Run Circle Mailstop OM1-800Owings Mills, Maryland 21117

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.