Blue Health Intelligence: Resource Will Enhance Knowledge Sharing

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1 Briefs Volume 11, Number 3 Fall 2006 Blue Health Intelligence: Health Data Resource for Employers What to Do When Medicare Is the Secondary Payer Four Ways to Get a Free Flu Shot

2 Blue Health Intelligence: Resource Will Enhance Knowledge Sharing The Blue Cross and Blue Shield Association recently announced Blue Health Intelligence, a new health data resource for employers. Consisting of a secure database of aggregate data with no personally identifiable information Blue Health Intelligence will help employers make more informed decisions about the health care benefits and resources they offer to their employees. The Blue Health Intelligence (BHI) database currently contains HIPAA-compliant claims information on 79 million Blue Plan members and is the largest source of health care data and analysis, public or private. Employers will have access to information that is current, complete, relevant, reported by geography and industry, and comparable to companies with similar health care experiences. Access to the health costs and utilization data will be available only to participating Blue Plans, such as Blue Cross and Blue Shield of North Carolina, beginning in Why Was BHI Developed? The health care market is moving toward an evidencebased, decision-making model. Employers, consumer and providers are demanding credible and actionable data, and BHI will help to meet that need. As Blue Health Intelligence evolves, the resource will provide a number of benefits to employers, consumers, providers and other stakeholders, such as: Benchmarking data to assist in conducting comparative analyses across a number of health care components. Sharper insight into health care costs and best clinical practices. Information about the efficacy of certain treatments and new medical technologies, as well as emerging trends in health care practice and delivery. Opportunities for health services research. Eventually, BHI will offer consumers access to comparative information that supports their health care decision-making to ensure that they receive the right care at the right time and in the right place. Blue Health Intelligence is currently being pilot-tested and will be operational in If you have questions about this health resource, please contact your BCBSNC account manager. 2

3 Copayment Waiver Extended for Generic Rx Drugs Remind your employees that if they have a prescription to fill, now is the time to consider getting a generic drug instead of a brand-name prescription. Blue Cross and Blue Shield of North Carolina s generic copayment waiver program, which began in February, will be available through December 31, All BCBSNC members need to do to take advantage of this cost-saving initiative is to present a prescription for a generic drug to a participating BCBSNC pharmacy. The copayment, or any applicable coinsurance costs, will automatically be waived when the prescription is filled. Please note that any prescription drug deductible must be met before the member is eligible for the waiver. The 2006 generic copayment waiver program is open to members of fully insured and self-funded employer groups purchasing pharmacy benefits from BCBSNC. For eligible groups with employees living out-of-state, please let your employees know that if they go to a participating Medco pharmacy and choose a generic drug, the copayment waiver will apply. Generics Save Members Money BCBSNC members may continue to choose highercost brand-name drugs even when generic alternatives are available or authorized by their doctor. However, BCBSNC is encouraging members to discuss prescription drug options with their physicians and decide together if a generic drug might be an appropriate alternative to a brand-name choice. Generic drugs are held to the same safety, efficacy and manufacturing standards by the U.S. Food and Drug Administration as their brand-name equivalents, but usually cost significantly less. Members whose prescription drug coverage is through BCBSNC will receive their 2006 member formulary in the fall issue of Active Blue magazine in October. This handy little booklet can help members make informed choices when talking to their doctor about choosing the right medication for them. BCBSNC s prescription drug formulary is kept up-to-date on our Web site at bcbsnc.com, and we encourage members to refer to the Web site for the most current list prior to getting a new prescription. 3

4 What to Do When Medicare Is the Secondary Payer From time to time, Medicare may send you a notice that it has identified a member for whom Medicare has mistakenly made primary payments for services. This happens when Medicare discovers that a beneficiary had other primary coverage at the time Medicare paid for the services in question. If you receive one of these notices Medicare Secondary Payer Recovery Demand Letter or an Intent to Refer Debt to Treasury Package please forward the notice and all accompanying documentation to your Blue Cross and Blue Shield of North Carolina (BCBSNC) account manager as soon as possible, as this is a timesensitive process. You can also choose to authorize us to act and respond on your behalf by including an authorization with the notice. If you do not make this selection, Medicare will continue to pursue you if there are outstanding issues or questions in the case. The authorization must: Be on your company s employer letterhead. Specifically authorize the Centers for Medicare and Medicaid Services (CMS), its Medicare contractors, their employees and agents, and the Department of the Treasury and its employees, contractors and agents to disclose to BCBSNC any and all information related to the debt identified in the Medicare Secondary Payer recovery demand letter until the debt is closed. Include the date of the demand letter. Include the name of the entity sending the demand letter. Include the Medicare beneficiaries names and their health insurance claim numbers. Specify that the document authorizes BCBSNC to resolve the identified debts on your employer group s behalf. 4 A sample authorization that meets the above requirements is available for your reference on the I m an Employer page of b c b s n c. c o m. Just click on the Important News bullet in the Group Administrator s Toolkit. Your BCBSNC account manager will forward the information to the appropriate area within BCBSNC for review. BCBSNC will provide one of the following resolutions: A valid, documented defense for why the debt is not owed. Evidence that BCBSNC already paid the debt prior to receiving the notice. Payment to the requestor (CMS or authorized contractor), including any applicable interest. If you have any questions, please contact your BCBSNC account manager.

5 Four Ways to Get a Free Flu Shot It s almost flu season again. The flu can spread easily and quickly in the workplace. If an employee gets the flu, he or she will likely be sick for about a week, with some lingering symptoms lasting as long as a month. Why take a chance? Encourage your employees and their covered dependents to get a free flu shot this year. The Centers for Disease Control and Prevention (CDC) recommend annual flu shots for people who are age 50 and older, have a chronic illness, have a weakened immune system, are pregnant, or are likely to come in close contact with people at risk of serious influenza. Blue Cross and Blue Shield of North Carolina (BCBSNC) is offering four ways for eligible members to get vaccinated free of charge this flu season. Nonmembers can receive a flu shot for $25 (cash or check only) at a regional, retail and worksite flu shot clinic. 1. Regional Clinics: From October 3 through November 8, BCBSNC will host regional flu shot clinics across the state. A list of all regional clinics and the dates and times that they will be held is available on our Web site at bcbsnc.com/flu. 2. Retail Clinics: From October 1 through the month of November, members can visit one of more than 700 pharmacies and grocery stores around the state that will be offering free flu shots, while supplies last. To find a location near you and to check the schedule of free flu shot retail clinics in your area, please call or visit bcbsnc.com/flu. 3. Worksite Clinics: Employer groups with 100 or more BCBSNC-covered employees have the opportunity to host on-site worksite clinics. If you have already signed up to host a clinic, your BCBSNC-covered employees (and covered dependents if you choose to include them) will receive free flu shots. 4. Doctor s Office: If their policies include preventive health benefits, most members can get flu shots from their physician at no charge. Unless an office visit is scheduled in addition to the flu shot, there will be no charge for the vaccination in most cases. Members should check their benefit booklet for more information about their preventive care benefits. Encourage your BCBSNC-covered employees and their covered dependents to get a free flu shot this fall and stay healthy. 5

6 Taking Care of North Carolina North Carolinians have grown to rely on the stability of Blue Cross and Blue Shield of North Carolina (BCBSNC). For 73 years, BCBSNC members have been confident that their medical expenses would be met during a routine doctor s visit or in a serious medical emergency. We re proud to have earned our members trust. North Carolinians have responded to our efforts by making us one of the fastest-growing Blue Plans in the nation. BCBSNC has increased its membership by more than 31 percent since 2001 and now serves nearly 3.4 million members. Headquartered in Chapel Hill, BCBSNC serves all 100 North Carolina counties through customer service centers in Durham and Winston-Salem and regional offices in Charlotte, Greensboro, Greenville, Hickory, Raleigh, and Wilmington. These local facilities help us serve you and our members better er and faster. The statistics listed below will give you an idea of the current scale of our daily operations: Number of claims processed: more than 117,000 Value of claims handled: more than $25 million Members served: nearly 3.4 million If you would like more details about our operations and our expanded role in the state, please view our mini-book, Taking Care of North Carolina, online at bcbsnc.com. Just go to Inside BCBSNC and click on Taking Care of North Carolina to find out more. BCBSNC currently employs more than 4,000 workers. Our company has grown to serve one in three North Carolinians. We have a tremendous impact on our state more than many people realize. 6

7 Have You or Your Employees Talked to Us Lately? If you or your employees have called us in the last few months, then you already know that we have replaced our old touchtone system with a new speech recognition system similar to those used by many banks and airlines. The new system lets callers answer short and simple questions with their voice rather than having to press 1 or press 2. You can even interrupt the system if you already know the answer to a question. Whether you or your employees have a question about benefits or our Web site, our new and improved phone system will get you to the right person. Help Us Help Your Employees Please instruct your employees to have their ID card available when they call us. Here s the information they may be asked for, depending on the reason for their call: Relationship to the patient (the person they re calling about) The patient s subscriber number (including the letters) The patient s date of birth The patient s ZIP code The claim date of service The more information your employees can provide upfront, the more quickly our representatives will be able to assist them. And don t worry all data that is provided upfront will be carried throughout the call even if the caller needs to speak to more than one representative. Our system can understand callers best if they use a regular handset rather than a speakerphone or cell phone and speak in their normal voice (speaking louder or more slowly than normal will actually make it more difficult for our system to understand them). Please ask your employees to try to place their calls in a quiet area where there is not a lot of background noise. New Menu Options Our improved phone system includes the following menu options: Claims Find out why the payment for a specific medical service was processed the way it was Benefits Find out what is covered, or locate an in-network provider Something Else Get help with our Web site, or get answers to general questions Please remind your BCBSNCcovered employees that many of their customer service needs can be handled using our secure My Member Services Web site. My Member Services is available 24 hours a day, seven days a week, and allows members to verify benefits information, check the status of a claim, update their address, or request a duplicate ID card. Visit bcbsnc.com/members to find out more. For Your Convenience How to reach our regional offices: WESTERN REGION CHARLOTTE REGIONAL OFFICE 8701 Red Oak Blvd., 3 rd Floor Charlotte, NC HICKORY REGIONAL OFFICE rd Avenue Lane SE Hickory, NC TRIAD REGION TRIAD REGIONAL OFFICE 2303 W. Meadowview Road, Suite 200 Greensboro, NC TRIANGLE REGION RALEIGH REGIONAL OFFICE 2501 Aerial Center, Suite 200 Morrisville, NC EASTERN REGION GREENVILLE REGIONAL OFFICE 100 Fox Haven Drive Greenville, NC WILMINGTON REGIONAL OFFICE 2005 Eastwood Road, Suite 201 Wilmington, NC NATIONAL ACCOUNTS HEADQUARTERS 3100 Tower Blvd., Suite 300 Durham, NC

8 Raise Awareness About Breast Cancer at Your Work Site According to the National Cancer Institute, an estimated one in eight women in the United States will develop breast cancer at some point in her life. In 2006, about 212,920 new cases of invasive breast cancer will be diagnosed among women in the United States. The good news is that the number of women dying from breast cancer is decreasing because of early detection and improved treatment. Routine mammograms are the best way to detect cancer early. Early detection greatly increases the likelihood that breast cancer treatment can be successful. The American Cancer Society recommends that women ages 40 and older have a screening mammogram every year as part of their routine annual health care. Free Posters Available To help you spread the word about the importance of routine mammogram screenings, Blue Cross and Blue Shield of North Carolina (BCBSNC) is offering free breast cancer awareness posters to work sites. To request posters, you can us at partnerships@bcbsnc.com or call us at Please provide us with your name, your company s name, phone number, mailing address, and the number of posters that you need. We recommend placing them in break rooms, women s restrooms, hallways and other gathering areas. Make sure that your workforce is aware of their preventive care benefits. Encourage women at your company to schedule their mammogram today. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. SM1 Marks of the Blue Cross and Blue Shield Association. SM Marks of Blue Cross and Blue Shield of North Carolina. U4071, 08/06 Durham, NC PRSRT STD U.S. POSTAGE PAID BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA Briefs Susan Lovett, Editor