Questions: Contact your professional relations representative or provider network services in Topeka at (785) 291-4135 or (800) 432-3587.

Acknowledgment: Current Procedural Terminology (CPT®) is copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable ARS/DFARS Restrictions Apply to Government Use.

Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.Codes published herein are current on the publication/effective date and are subject to change.

Sent To: CAP excluding Dentists and PharmaciesContains Public Information

Email key to avoiding QBRP disruption

When personnel responsible for receiving electronic communications leaves your office, remember to sign up another email address as not to disrupt the Quality-Based Reimbursement Program (QBRP).

A prerequisite of QBRP is to receive all communication electronically. Paper communication begins when an email returns from an invalid address and a provider’s office has no other valid email addresses in the system.

To sign up a valid email, go to http://www.bcbsks.com/CustomerService/Providers/enews_professional.htm and enter the necessary information.

QBRP REFRESH EFFECTIVE JULY 1

A QBRP refresh was conducted as referenced in the S-4-14 newsletter to determine if providers are continuing to earn the incentive payments effective earlier in the year.

If the refreshed data indicated a provider is no longer meeting metric(s) to earn an incentive(s), then the associated QBRP incentive ceased effective July 1.

Periodic monitoring will be conducted to verify the metric(s) are met to earn the incentive(s).

Providers are notified electronically if an incentive is stopped and/or when an incentive begins.

WHAT’S INSIDE ?

• Email key to avoiding QBRP disruption ..........................1

• QBRP refresh effective July 1 ......1• Immunization key

to controlling shingles ...................2• Claims eligibility enhanced ...........2• ICD-10 will not be delayed ............2• Pharmaceutical

formulary update ...........................2• Out-of-area precertification ...........3• Use a subject line

when emailing ...............................3• Web access for liaisons ................3• Billing reminders ...........................3• Availity unveils new screens ......4-5• A guide to BCBSKS networks .......6• Web updates — Medical policy ....6

The Professional Provider Report is published by the professional relations department of Blue Cross and Blue Shield of Kansas.

OUR WEB ADDRESS:http://www.bcbsks.com

Dustin Kimmel, Communications Coordinator

An Independent Licensee of the Blue Cross Blue Shield Association.

JUNE 30, 2015S-2-15

ReportProfessional

ProviderA Newsletter for Professional Providers and their Staff Members

Page 2 Sent To: CAP excluding Dentists and PharmaciesContains Public Information

June 30, 2015 PROFESSIONAL PROVIDER REPORT S-2-15

Pharmaceutical Formulary

UpdatePrime Therapeutics

updates the Blue Cross and Blue Shield of Kansas formulary (preferred medication list) on a quarterly basis. Please refer to the link below when prescribing or dispensing medications for your BCBSKS patients. Coverage is subject to the limitations of the member’s individual plan.

A searchable version of the formulary is available at:

► https://www.myprime.

com/content/dam/prime/memberportal/forms/2015/FullyQualified/Other/ALL/BCBSKS/COMMERCIAL/KSPREFDRUG/KS_Alpha_Drug_List.pdf

Cases of shingles are on the rise nationally and globally, with one in three people getting the virus according to the Centers for Disease Control and Prevention.

While cases are on the rise, the number of vaccinations hasn’t grown accordingly. The Zoster

vaccine for shingles should be administered once after the age of 60 or sooner, if determined necessary.

For more information or to confirm eligibility and benefits at the time of service, securely log on through Availity.com.

Zoster vaccine key to shingles control

Blue Cross and Blue Shield of Kansas (BCBSKS) is tightening eligibility edits in August.

Editing requires a match of the membership ID to the last name, first name and date of birth.

The edit logic, edit code, and implementation date will be posted in the near future under the News

section at http://www.ask-edi.com.BCBSKS encourages the use

of Real Time Eligibility transaction 270/271 through your clearinghouse or Availity to confirm eligibility and benefits at the time of service.

Sign up for email notification at http://ask-edi.com/listserver/all_list_signup.htm.

Claims eligibility editing gets enhancements

After many years of preparation, ICD-10 will be implemented Oct. 1. New ICD-10 editing was posted to the ASK website June 8. ICD-10 editing will be implemented Oct. 1. To sign up for notifications regarding ICD-10 editing and testing, go to http://ask-edi.com/listserver/all_list_signup.htm.

For questions regarding the ICD-10 transition before and after implementation, contact your professional relations representative through provider network services in Topeka at (785) 291-4135 or (800) 432-8537.

ICD-10 implementation ready for Oct. 1, 2015

EXPANDED EDI HOURSThe ASK EDI

Help Desk is now available from 7 a.m. to 4:30 p.m. Monday through Friday.

The help desk can be reached at (800) 472-6481 option 1 or askedi@ask-edi.com.

Page 3Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.Note: Codes published herein are current on the publication/effective date and are subject to change.

June 30, 2015PROFESSIONAL PROVIDER REPORT S-2-15

► Remember to fill out boxes 4, 7 and 11a completely on the CMS 1500 form to avoid a claim being denied for incorrect or incomplete information (code JP on remittance advice).

Writing “same” or “none” in any of these boxes will result in the claim being denied with the code JP, which will represent an error in personal information.

► When coding a claim, remember to use the modifier GA to denote a charge is a patient’s responsibility.

The system cannot read notes on a claim, making the use of the modifier crucial. If a provider has signed a waiver, using GA is a requirement.

► Applied Kinesiology services may be medically justified with appropriate documentation. Billing for Applied Kinesiology services should be billed under the appropriate Chiropractic Manipulative Treatment Codes (98940-98943) or using 97140 (Manual Therapy).

Billing reminders

► When billing Levonorgestrel-Releasing Intrauterine Contraceptive system (J7302), an NDC number must be included or the claim will be returned requesting more information.

The procedure code is used for Mirena (IUD) and Liletta (IUD).

► Air ambulance providers must file claims to the local Blue Plan in the service area where the patient point of pickup occurred based on zip code.

The zip code of the patient point of pickup should be placed in Box 23 of the paper CMS-1500 claim form (version 02/12) or in the 2310E NM4 field — Ambulance Pick-up Location City, State, Zip Code, electronically.

Blue Cross and Blue Shield of Kansas (BCBSKS) offers Electronic Provider Access (EPA) for providers to access precertification requirements for out-of-area members.

Go to http://www.bcbsks.com/CustomerService/Providers/MedicalReview/pre-cert_pre-auth.htm to find the page at right. Out-of-area Blue Plan’s general precertification/pre-authorization information is available by typing in the alpha prefix — the three letters in front of a membership number on the ID card

— and clicking “GO.”Some group plans may have terms

of coverage or benefits that differ. To verify coverage or benefits, securely log on through Availity.com.

Out-of-area precertification

BCBSKS offering web access for liaisonsBlue Cross and Blue Shield of

Kansas initiated a pilot program for contracting physicians to participate in annual specialty liaison committee meetings.

If you are a contracting physician interested in participating, please send your name, email address and specialty to BCBSKSLiaisonWebinar@bcbsks.com. An email should be received the Friday before the meeting. Please note that your email address will be used for this purpose only.

This will last about 30 minutes and be a listen-only experience during the meeting, but questions may be submitted electronically. Questions will be reviewed at a later date.

LIAISON WEBINARSThe following specialties may be available, and the meeting time is 5:15 p.m. on the date listed:

• Family Practice, July 9• OB/GYN, July 16• Pediatric, July 23• Otolaryngology, July 30• Surgery, Aug. 13• Urology, Aug. 20• Internal Medicine, Aug. 27

Use a subject line when emailingRemember to include a subject line

when emailing Blue Cross and Blue Shield of Kansas.

Emails without subject lines are identified as potential risks and are deleted without being opened.

When emailing provider network services at

Prof.Relations@bcbsks.com, the subject line should include either the provider’s name and NPI or the group name and tax identification number.

If a response is not received within 48 hours, contact provider network services at (785) 291-4135 or (800) 432-3587, option 1.

Page 4 Sent To: CAP excluding Dentists and PharmaciesContains Public Information

June 30, 2015 BLUE SHIELD REPORT S-2-15

Blue Cross and Blue Shield of Kansas (BCBSKS) providers now can check eligibility and benefits using Availity’s new eligibility and benefits service.

Providers can access the Availity Web Portal by going to the BCBSKS Provider Web Page on the BCBSKS website and logging into Availity.

Once logged in, click Eligibility

and Benefits/New Eligibility and Benefits Inquiry in the Availity menu and then view the following new enhancements to the Availity screens.

Availity unveils new screens

SCREEN NO. 1: CHECKING ELIGIBILITY AND BENEFITSA. When you select a payor, the

request fields for that payor are displayed on the page.

B. Select the Submit another patient check box to submit multiple requests in succession.

C. For each request you submit, a patient card displays in the patient history list.

D. Select a filter to display patient cards for requests you submitted only or for all requests submitted by your organization. Patient cards can be filtered by status.

►A

►

D

►

C

►B

SCREEN NO. 2: VIEWING ELIGIBILITY AND BENEFITSA. Click a patient card to view a

patient’s eligibility and benefits information.

B. Click the available links to access value-added services and information on the payor’s website. Note — Links and value-added services vary by payor.

C. Click the Patient Information tab to view information about the patient, subscriber, plan, and more.

►

A

►

C

►

B►

Page 5Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.Note: Codes published herein are current on the publication/effective date and are subject to change.

June 30, 2015BLUE SHIELD REPORT S-2-15

for eligibility and benefitsSCREEN NO. 3: VIEWING ELIGIBILITY AND BENEFITSA. Click the Coverage and Benefits

tab to view information about the patient, subscriber, plan, and more.

B. Select a filter to display the network benefits, out-of-network benefits, or all benefits.

C. Click a benefit to jump to that benefit in the results.

D. Click Print to print the coverage and benefits information.

E. Click Feedback to let Availity know if any eligibility and benefits information is missing or incorrect.

►

E

►B

C

►

D

►

►

SCREEN NO. 4: NEW PAYOR SPACES NAVIGATION BARYou can now access a payor

space using the new Payor Spaces navigation bar.A. Click Payor Spaces in the new

navigation bar, then click the payor space.

Blue Cross and Blue Shield of Kansas

►A

To access Availity Help, click Help at the top of any Availity page.

If you do not see these enhancements upon login, ask your Availity Primary Access Administrator (PAA) to grant you access to this feature. To determine who your PAA is, click your Account menu option at the top of any Availity page and then click Who Controls My Access?

For more information on Availity and the new Eligibility and Benefits screens, click on a link below.

• Check Eligibility and Benefits• Using the Patient History List• View a demo• View a webinar recording

If you have any questions regarding Availity and the new screens, please contact your professional relations representative.

►

A

Page 6 Sent To: CAP excluding Dentists and PharmaciesContains Public Information

June 30, 2015 BLUE SHIELD REPORT S-2-15

The Exchange, BlueCard and Kansas Provider Networks booklet is available to help providers understand the Marketplace, Blue Cross and Blue Shield of Kansas products, and provider networks including BlueCard.

Among the information provided is a link to Quick Guide to BCBS Member ID Cards, a publication from the Blue Cross and Blue Shield Association designed to help providers with questions regarding membership cards for all Blue Plans.

The brochure can be found at http://www.bcbsks.com/CustomerService/Providers/Publications/professional/manuals/pdf/prof_Exchange-BlueCard-and-Kansas-Provider-Networks.pdf

Web Changes — Medical Policy

• Accelerated Breast Irradiation After Breast-Conserving Surgery for Early Stage Breast Cancer and Breast Brachytherapy as Boost with Whole-Breast Irradiation

• Actigraphy• Alcohol Injection Therapy for Morton’s

Neuroma• Androgens and Anabolic Steroids• Anodyne® — Skin Contact Monochromatic

Infrared Energy as a Technique to Treat Cutaneous Ulcers, Diabetic Neuropathy, and Miscellaneous Musculoskeletal Conditions

• Antidepressant Agents • Artificial Intervertebral Disc: Lumbar Spine • Assays of Genetic Expression in Tumor

Tissue as a Technique to Determine Prognosis in Patients With Breast Cancer

• Bio-Engineered Skin and Soft Tissue Substitutes

• Biologic Immunomodulators Therapy • Bone Mineral Density Studies • Cardiac Hemodynamic Monitoring for

the Management of Heart Failure in the Outpatient Setting

• Cardiovascular Magnetic Resonance (CMR) • Catheter Ablation as Treatment for Atrial

Fibrillation • Cerdelga® (eliglustat) • Computer-Aided Evaluation of Malignancy with

Magnetic Resonance Imaging of the Breast• Cone Beam Computed Tomography

(CBCT) (requires Availity log-in) • Cryosurgical Ablation of Primary or

Metastatic Liver Tumors • Cytoreductive Surgery and Perioperative

Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

• Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions

• Extracranial Carotid Angioplasty/Stenting • Facet Joint Denervation (Cervical and Lumbar)• Fundus Photography • Genetic Testing for Predisposition to

Inherited Hypertrophic Cardiomyopathy • Glucose Test Strips/Disks • Hereditary Angioedema (Berinert, Cinryze,

Firazyr, Kalbitor, Ruconest) • Human Growth Hormone • Identification of Periodontal Microorganisms

(requires Availity log-in)• Implantable Bone-Conduction and Bone-

Anchored Hearing Aids

• Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence

• Intravenous and Subcutaneous Immune Globulin Therapy

• KRAS, NRAS, and BRAF Mutation Analysis in Metastatic Colorectal Cancer

• LASIK (laser assisted in situ keratomileusis) • Lysosomal Storage Disorders • Magnetic Resonance Spectroscopy • Measurement of Exhaled Nitric Oxide

and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders

• Meniscal Allografts and Other Meniscus Implants

• Molecular Analysis for Targeted Therapy of Non-Small Cell Lung Cancer

• Molecular Panel Testing of Cancers to Identify Targeted Therapies

• Multiple Sclerosis Agents • New to Market Drugs (Including: Afrezza

[human insulin]) • Optical Coherence Tomography (OCT) of

the Anterior Eye Segment • Oral Immunotherapy Agents (Grastek®,

Oralair®, Ragwitek™) • Oscillatory Devices for the Treatment of Cystic

Fibrosis and Other Respiratory Disorders• Outpatient Pulmonary Rehabilitation Programs• Pachymetry • Panniculectomy and Abdominoplasty • Pneumatic Compression Pumps for

Treatment of Lymphedema and Venous Ulcers (for Home Use)

• Posterior Tibial Nerve Stimulation • Prophylactic Mastectomy • Scanning Computerized Ophthalmic

Diagnostic Imaging Devices • Scintimammography and Gamma Imaging

of the Breast and Axilla • Screening for Lung Cancer Using CT

Scanning• Sensorimotor and Neurobehavioral Status

Exams for Optometric Providers • Transcatheter Aortic Valve Implantation for

Aortic Stenosis • Tysabri® (natalizumab) and Lemtrada™

(alemtuzumab) (IV Multiple Sclerosis Agents)

• Ultrasound Accelerated Fracture Healing Device

• Ultraviolet Light Therapy for Skin Conditions • Vacuum Assisted Wound Closure (VAC)

Since the publication of Blue Shield Reports S-1-15, the following new or revised medical policies have been posted to our website at: http://www.bcbsks.com/CustomerService/MedicalPolicies/policies.htm

An Independent Licensee of the BlueCross BlueShield Association.

BCBSKS network guide