In this issue of BlueLinks eNews: |
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Welcome February 2009 Dear Business Partner: Earlier today we announced our 2008 year-end earnings, and the company's strong performance is a direct result of your ongoing efforts. We are grateful for your contributions—especially for the time you take to learn about our new products and services. In an evolving health care landscape, your dedication has helped us maintain the highest possible quality of service and value to your clients. This edition of BlueLinks eNews contains a great offer for accounts that enroll in health and dental coverage through Blue Cross Blue Shield of Massachusetts and ancillary benefits with Indigo™ Insurance Services. You'll also read about our range of personal spending account (PSA) administrators for consumer-directed health plans. This BlueLinks also contains important updates on new prior authorization requirements, our 2009 enrollment policy, Medicare Part D late enrollment penalties, and how we are notifying members regarding their lifetime dollar benefit maximums. We also introduce a new tool for quoting Indigo ancillary products to small groups—an online utility that we are very excited about. This month's BlueLinks is packed with important information that can help you throughout 2009. If you have any questions or comments, please don't hesitate to share them with your account executive. Sincerely, Carlos Cubia |
Fourth Quarter 2008 Earnings Announcement
Today we reported our fourth quarter 2008 financial results. We could not have achieved such strong results in today's competitive environment without your ongoing dedication and support. We appreciate the opportunity to continue serving you and your clients.
For details about our fourth quarter results, please read our recent press release. If you have any questions, please contact your account executive.
Keeping Health Care Affordable: Quality = Affordability
The rising cost of health care is an unsustainable burden on families and businesses across the Commonwealth. At Blue Cross Blue Shield of Massachusetts, we believe the most promising way to moderate the cost of health care is by improving the quality of care. It's the reason we are fundamentally changing the way we pay for the care our members receive. Right now, doctors and hospitals mostly get paid based on the quantity, not quality of their services. We have introduced an innovative new contract model called the Alternative Quality Contract (AQC) that pays and rewards doctors and hospitals based on the quality and clinical outcome of the care they provide to our members. We believe that paying and rewarding doctors and hospitals based on the quality and clinical outcome of the care they provide to our members will result in higher quality, more affordable care for all.
Alternative Quality Contract
As part of these efforts, we have introduced a revolutionary new provider agreement that we call the Alternative Quality contract. Our Alternative Quality Contract combines two forms of payment: a global, or fixed, payment per patient adjusted for health status, which increases annually with inflation; and substantial performance incentives tied to the latest nationally accepted measures of quality, effectiveness, and patient experience of care.
During the past two months, we were excited to announce the first physician and hospital groups that have chosen to partner with us on this new contract model. The groups include Mount Auburn Hospital and the affiliated Mount Auburn Cambridge Independent Practice Association, Hampden County Physician Associates, LLC, and Tufts Medical Center and its affiliated physicians. If you have any questions, please contact your account executive.
Save Time and Money with Convenient One-Stop Shopping
We have great news for Massachusetts-based companies with 2 to 99 employees. When they offer Dental Blue® along with coverage for two or more group ancillary products* from Indigo™ Insurance Services, they will:
- Save four percent on their Dental Blue coverage
- Simplify their bill paying with a single electronic bill for dental, health, and ancillary plans
- Enjoy convenient one-stop shopping for all their insurance needs
For more information on these great benefits and savings, contact your account executive.
* Group ancillary coverage options include Group Term Life, Group Short Term Disability, and Group Long Term Disability.
Out-of-Network Reimbursement for PPO Plans
The out-of-network coverage for services provided by non-participating physicians and other covered non-participating professional providers for members of our Blue Care ElectSM and Preferred Blue PPOSM plans will be based on our indemnity (usual and customary*) fee schedule.
Beginning January 1, 2009, claim payments for covered PPO services provided by most non-participating physicians and other covered non-participating providers will be calculated based on Blue Cross Blue Shield of Massachusetts' standard indemnity fee schedule or the provider's actual charge, if it is less than the standard fee schedule. This change will affect new as well as existing PPO clients on renewal beginning January 1, 2009.
In instances when a non-participating provider's charges are more than the standard indemnity fee schedule, the member will be responsible for the difference, plus any applicable cost-sharing amount. For this reason, members may wish to discuss charges with their providers before they receive covered services. (Note: This change will not affect claim payments for services received outside of Massachusetts from a provider that participates with the local Blue Cross and/or Blue Shield plan.)
This change does not apply to non-participating, hospital-based emergency medicine physicians or hospital-based anesthesiologists, pathologists, or radiologists. If you have any questions about this change, please contact your account executive.
* The "usual and customary" charge, also referred to as the allowed charge, is based on the standard fee schedule that Blue Cross and Blue Shield has established for its indemnity product participating physicians and other participating professional providers.
Clarifications for PPO/HMO Plans Regarding Reimbursement for Non-Participating Emergency Medicine, Radiologists, Anesthesiologists, and Pathologists
The following clarification affects hospital-based emergency medicine, radiologists, anesthesiologists, and pathologists who do not participate in our PPO and/or HMO networks and whose billing is not handled through a participating group. Effective January 1, 2009, when a member receives a covered service from a non-participating hospital-based emergency medicine, radiologist, anesthesiologist, or pathologist who does not participate in the network for the member's plan, Blue Cross and Blue Shield of Massachusetts will pay the subscriber directly for these services. It is the responsibility of the subscriber to pay the provider. The provider is responsible for collecting payment from the subscriber. For more information, view the chart of affected hospitals or contact your account executive.
Blue Cross Blue Shield of Massachusetts members have an option for obtaining, non-urgent medical care. Limited services clinics (LSCs), such as MinuteClinics®' and Take Care ClinicsSM', provide minor, non-emergency medical care without an appointment for a limited set of services, including providing flu shots and treatment for colds and ear infections. These clinics can offer a more efficient setting for these types of care than a hospital emergency room, and more convenient access than most doctors' offices because they are open during evening and weekend hours. The member copayment or cost is the same that a member pays for similar covered services at a primary care provider. Referrals and prior authorizations are not required for any member to receive treatment from these providers.
MinuteClinic (CVS/pharmacy®')
Blue Cross Blue Shield of Massachusetts is currently contracted with the MinuteClinic LSCs located at select CVS pharmacies. To date, there are 13 MinuteClinic locations in Massachusetts with plans by CVS to open 15 additional locations in 2009. MinuteClinics currently participates in all Blue Cross Blue Shield of Massachusetts products except Medicare Advantage. Effective April 1, 2009, MinuteClinic will also be part of the Medicare HMO Blue and Medicare PPO Blue networks and be able to treat Blue Cross Blue Shield of Massachusetts Medicare Advantage Members.
Take Care Clinics (Walgreens)
Blue Cross Blue Shield of Massachusetts is currently in negotiations to begin covering health care services at Take Care Clinics at select Walgreens pharmacies later this year.
Participating Clinic Locations
We expect that there will be approximately 50 LSC locations across Massachusetts by year-end. As new locations are opened and added to our network, this information will be updated on our Find a Doctor website. Members can also call the Member Service number on their ID card to find a participating location. National account members are permitted to obtain treatment at LSC locations outside of Massachusetts if the location is contracted with the local Blue Cross and Blue Shield plan.
If you have any questions about LSCs, please contact your account executive.
Statutory Requirements Regarding Nurse Practitioners as Primary Care Providers
A new Massachusetts statute requires insurers to allow their members to select a plan participating nurse practitioner (NP) as a primary care provider (PCP) and to include participating NPs in all paper and electronic provider directories.
In response to the new requirements, Blue Cross Blue Shield of Massachusetts is implementing a process to enable members to choose an NP as their primary care provider. Blue Cross Blue Shield of Massachusetts already includes NPs in our online and paper directories and has contracted with NPs for all products since 2001. In our implementation of the statute, we are collaborating with the Massachusetts Coalition of Nurse Practitioners and will notify plan participating NPs and PCPs as this implementation proceeds.
Personal Spending Account Administrators
Blue Cross Blue Shield of Massachusetts is dedicated to providing employers with the flexibility to choose the right consumer-directed health plan solution for their employees. To this end, we have developed relationships with several experienced, high performing personal spending account (PSA) administrators.
Bank of America
Your clients can now take advantage of special pricing on Health Savings Accounts (HSAs) from Bank of America when paired with one of our HSA-compliant, "Saver" plans. This solution gives members access to reliable service and support, debit cards, online enrollment, and traditional online banking functions, such as bill pay, electronic transfer, and scheduled contributions.
If you would like more information about Bank of America's HSA solution, call them at
Wells Fargo
With Wells Fargo, your accounts can offer an HSA with coordinated service and support at competitive fees when offered with one of our HSA-compliant, "Saver" plans. This solution gives members access to comprehensive support, investments and other plan management tools, as well as quarterly plan reporting.
Learn more about Wells Fargo PSA solutions.
Benefit Concepts
Our partnership with Benefit Concepts delivers claims and enrollment data integration and coordinated customer support for Health Reimbursement Arrangements (HRAs) and Flexible Spending Accounts (FSAs). In addition, when your clients work with Benefit Concepts through us, they have access to a preferred level of support. This includes a specially trained member service team and joint client support teams that are always ready to resolve employer issues.
NOTE: Benefit Concepts is only available to clients when 25 or more participants will enroll in the PSA.
Learn more about Benefit Concepts PSA solutions.
Preferred Third Party Administrators
Your clients can also work directly with one of our preferred PSA administrators to support one of our medical plans. They are: Choice Care Card™, ConnnectYourCare, and Benefit Strategies. These administrators take advantage of weekly medical, dental, and pharmacy claims feeds from Blue Cross Blue Shield of Massachusetts to facilitate the timely and accurate processing of claims and reimbursements from HRAs and FSAs. Employers will work directly with these vendors to set up all the aspects of the PSAs. We do not currently charge a fee providing the claims feed.
Learn more about our preferred third party administrators.
For more information
If you have any questions about PSA vendor options or Blue Cross Blue Shied of Massachusetts medical options, please contact your account executive.
New Prior Authorization Requirements in 2009
Blue Cross Blue Shield of Massachusetts will implement new prior authorization requirements in 2009 for hip and knee replacement surgeries, sleep studies, and neuropsychological testing services as outlined below. These processes are being implemented to help ensure that the services being rendered are medically necessary. Blue Cross Blue Shield of Massachusetts will use InterQual®' evidence-based, nationally recognized, medical necessity review criteria to guide our medical necessity prior authorization determinations for hip and knee replacements and neuropsychological testing. Blue Cross Blue Shield of Massachusetts medical policy will be used in reviews for sleep studies.
Hip and Knee Replacement Surgeries and Sleep Studies
The prior authorization requirement for these services will be implemented for:
- Members in HMO/POS plans* seeking these services in an outpatient setting, as of May 1, 2009
- Members in all products* seeking these services in an inpatient setting, as of May 1, 2009
- Members in PPO* plans seeking these services in the outpatient setting, as of July 1, 2009
Neuropsychological Testing
The prior authorization requirement for these services will be implemented for:
- Members in HMO/POS* plans (for both in-network and out-of-network services), as of May 1, 2009
- Members in PPO* plans (for both in-network and out-of-network services), as of July 1, 2009
We will consider authorization of ADHD testing only if there are well-documented signs or symptoms that can be attributed to more than one condition, and for which neuropsychological testing can offer a clear resolution. Neuropsychological testing for the routine diagnosis of ADHD is not regarded as medically necessary and, therefore, will not be authorized. As a reminder, testing primarily for educational or vocational purposes is not a covered benefit. Additionally, HMO members are required to receive services from HMO network providers, and POS and PPO members are required to receive services from their network providers to be covered at an in-network level.
If you have any questions regarding these prior authorization requirements for 2009, please contact your account executive.
* Excluding Medicare Advantage, Federal Employee Program, and certain other non-group plan members
Non-Group Enrollment Policy Modification
Blue Cross Blue Shield of Massachusetts is modifying its policy for enrollment effective dates for individuals. The current policy allows individual coverage to become effective any day of the month (including the same day as they submit their application). Beginning March 7, 2009, coverage for individuals who apply for enrollment directly with Blue Cross Blue Shield of Massachusetts will become effective on either the 1st or the 15th of the month, depending on the date of the month during which they apply. For example, individuals will be allowed to purchase a plan that will be effective April 1st, up until the end of the day on March 15th. Individuals will be allowed to purchase a plan that will be effective April 15th up until the end of day on the April 1st. If you have any questions about this change, please contact your account executive.
Medicare Part D Late Enrollment Penalties Update
In the September 2008 issue of Important Administrative Information, we informed you of the late enrollment penalty (LEP) members with Medicare may be assessed who do not have "creditable" Medicare prescription drug coverage. Creditable coverage means that the retirees' prescription plan is actuarially equivalent or better than the standard Medicare Part D benefits. These assessments are now appearing in the premium invoices for your clients' Part D programs, as applicable per member.
As part of the LEP requirement, we will send letters to these members informing them of their LEP amount. Since the letter must reflect what the member will actually be responsible for, we will be sending out a survey to determine which employers or unions will be paying this amount on their members' behalf. The LEP letter to the member will inform them if their employer is paying the LEP on his or her behalf.
Employers and unions are under no obligation to pay the LEP on behalf of their members. It is a choice left up to the employer or union. We sent these surveys mid-February with a return request of March 1, 2009. The survey will request a simple "yes" or "no" response and can be completed via our website. Instructions will be included.
The survey will only be for our Part D programs under the Medicare Advantage plans, Medicare HMO Blue, Medicare PPO Blue, Blue Medicare PFFS and our stand alone Part D program, Blue MedicareRx.
If you have any questions, please contact your account executive.
Notifications for Members Nearing Their Lifetime Maximum
Some Blue Cross Blue Shield of Massachusetts health plans include lifetime benefit dollar maximums in their benefits. Though it's uncommon for a member to exceed his or her lifetime maximum, once a member exceeds their maximum, benefits for certain services are no longer available. Blue Cross Blue Shield of Massachusetts currently notifies affected members via an Explanation of Benefits (EOB) only when processed claims exceed the maximum. Starting this spring, Blue Cross Blue Shield of Massachusetts will notify affected members three times: first when a member's claims payments reach 75 percent of their plan's lifetime benefit maximum, again when they reach 90 percent of their maximum, and again when they exceed the maximum. If you have any questions about this change, please contact your account executive.
Indigo Online Calculator Makes Quoting Groups of 2-9 Easy
Effective immediately, Indigo Insurance Services has made a new tool available for you to get quick, detailed quotes for Group Term Life, Accidental Death and Dismemberment, Short Term Disability, and Long Term Disability benefits. Now, in addition to the BlueQuote system available for medical and dental quoting, this easy-to-use calculator gives you the ability to input a group's name and some basic information to produce a customized, printable quote in just a few minutes.
The online calculator is available to quote groups with 2-9 employees and is accessible to you at indigo-insurance.com.
Take a few minutes to get a feel for the calculator. We think you'll see how useful of it can be for your ancillary quotes for groups of 2-9.
If you have any questions, please contact your Blue Cross Blue Shield of Massachusetts representative.
If the above links are not functioning in your email, copy and paste the URLs listed below into a browser window:
Press Release
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/feb2009_press_release.pdf
Chart of Affected Hospitals
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/feb2009_chart_affected_hospitals.pdf
Find a Doctor
http://www.bluecrossma.com/member-central/find-a-doctor.html
Bank of America HSA Solution
http://www.bankofamerica.com/hsa
Wells Fargo PSA Solutions
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/feb2009_wells_fargo.pdf
Benefit Concepts PSA Solutions
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/feb2009_benefit_concepts_psa_solutions.pdf
Preferred Third Party Administrators
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/feb2009_claims_feed_vendors.pdf
Indigo Insurance
http://www.indigo-insurance.com/
Indigo Insurance Calculator
http://www.indigo-insurance.com/redirect/quote.html
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2009 Blue Cross and Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross Blue Shield Association. |