for Providers Healthy Snacking Benefits Contracted Providers in Bordering States Precertification FAQs

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April 2017 BlueNewsSM for Providers Contracted Providers in Bordering States Precertification FAQs Employee RX Drug Program Featured Webinars Important Reminders San Francisco Medical Center, who

1 April 2017 BlueNewsSM for Providers Contracted Providers in Bordering States Precertification FAQs Employee RX Drug Program Featured Webinars Important Reminders San Francisco Medical Center, who also contributes to health-oriented cookbooks. Healthy Snacking and Weight Control Avoiding extreme hunger increases the likelihood that you ll pick the healthy snack rather than raiding the doughnut box in the break room or overeating at meals. Megan Mullin, a nutritionist at Canyon Ranch SpaClub in Las Vegas, recommends that her clients eat small meals every three to five hours and that they resist the urge to overeat. The easy part is the frequent meals; the hard part is keeping them small. We are used to big meals, says Mullin. She recommends eating more during active times of the day: If you can match your intake with your output, you ll be better off with your weight-control goals. Another key is to keep healthy snacks on hand. The best way to avoid eating food that you shouldn t is to not keep any around, says Redberg. For the same reason, you re not supposed to go grocery shopping when you re hungry you buy a lot of stuff you really shouldn t. Healthy Snacking Benefits Resisting the urge to reach for a burger, candy or chips when you re hit with a snack attack can make a big difference in your health regardless of your age. Nutrition really is the key to a healthy lifestyle and a healthy life. It goes a long way toward lowering the risk for heart disease and improving overall health, says Dr. Rita Redberg, a cardiologist at the University of California, Curb Your Cravings Blood sugar dips three to five hours after you eat. Eating small, frequent snacks keeps your metabolism revved up and helps normalize blood sugar. Hunger can throw your body into famine mode, which slows metabolism and makes it easier to pack on the pounds. Foods like fruits, vegetables, nuts, low-fat dairy products, whole grains and legumes are satisfying and are packed with the nutrients, fiber and protein your body needs, and they guard against sugar highs and lows, so you are less likely to succumb to your sweet tooth or whatever your dietary Achilles heel may be. (con t)

Healthy Snacking and Energy, Mood and Brain Boosters I tell people to think about food as fuel, Mullin says. Such nutrient-poor, sugary snacks as candy bars are like fuel that runs hot and flames out.

Healthy snacks are more like slow-burning fuel that helps you keep going all day.

2 Healthy Snacking and Energy, Mood and Brain Boosters I tell people to think about food as fuel, Mullin says. Such nutrient-poor, sugary snacks as candy bars are like fuel that runs hot and flames out. They give you a quick jolt of energy that is followed by a crash that can leave you hungry, cranky, sleepy and unable to concentrate. Healthy snacks are more like slow-burning fuel that helps you keep going all day. Having several snacks a day helps banish that postmeal sleepiness that comes from consuming too many calories at one sitting. If you include protein in your snack, you ll derive an extra mental boost protein-laden food like fish, meat, eggs, cheese and tofu contain an amino acid that increases the production of neurotransmitters that regulate concentration and alertness. Many of us naturally reach for carbohydrates when we re feeling down because they help lift our mood by boosting the brain chemical serotonin. While processed foods like plain bagels and cookies give a quick high, it s followed by a sharp low. Good-for-you fruit sugars, honey, low-fat dairy products, whole grains and many vegetables lift mood and battle fatigue without the roller-coaster effect. Omega-3 fatty acids are another good nutrient to include in snacks, for your heart as well as your head. Tuna, walnuts and some other foods contain omega-3s, which help fight high blood pressure and heart disease, as well as depression and anxiety. The effects of omega-3s are also being studied as they relate to a number of other health conditions, including joint diseases, schizophrenia and attention deficit hyperactivity disorder. *Baertlein, Lisa. (2017, March 10). Healthy Snacking Benefits. Retrieved from healthy-snacking-benefits.aspx. For Our Contracted Providers in Bordering States Providers contracted with BlueCross BlueShield of South Carolina to participate in the Blue Essentials SM network, who have offices located in North Carolina and Georgia, should file all claims for those members directly to the South Carolina plan, not to your local (Home) plan. Work with your clearinghouse to determine the correct payer (carrier) ID to use for South Carolina when filing claims electronically. Blue Essentials members can be identified by these alpha prefixes: ZCF, ZCU or ZCQ. Please refer to the 2017 Member ID Card Guide to see examples of the ID cards. This guide can be found on the Resources pages of our provider websites. We appreciate you sharing this information with appropriate staff in your practice.

Answering Your Questions about Precertifications The table includes questions providers have asked about precertifications, with our responses.

3 Answering Your Questions about Precertifications The table includes questions providers have asked about precertifications, with our responses. Although we highlight frequently asked questions (FAQs) in our monthly newsletter, the best place to view the entire list of FAQs is in the Education Center of our provider website. We regularly add new questions and answers online at Your Question How can I complete a precertification request for two or more procedures such as a colonoscopy and endoscopy via My Insurance Manager SM? How can I have diagnoses added to the Fast-Track Request Option in My Insurance Manager? At times when I call the Plan to get a DME precertification, I m told the member s plan does not require an authorization for the item. However, when the claim is filed, it is denied for no authorization. Why? How can I edit the default diagnosis code when requesting a precertification for a procedure via the Fast-Track Request Option? Can I go directly to Novologix to complete a precertification request? Our Response Currently, you are unable to complete a precertification request for more than one service on a single entry using My Insurance Manager. Once you have chosen your request type and select one service, you will continue through the remaining precertification request screens to completion. At that time, you may begin a second request. Contact Provider Relations and Education to have a diagnosisprocedure combination considered for adding to the Fast-Track Request Option in My Insurance Manager. Always verify benefits and eligibility to find out if an item requires precertification. Generally, an authorization number is required for DME supplies costing more than $500. Users are unable to edit the diagnosis code when using the Fast-Track Request Option; this may be done via the Customized Authorization Request Option. My Insurance Manager defaults to a standard diagnosis for Fast-Track Request Options, but it does not prevent the requester from gaining an authorization number. Presently, you cannot go directly to the Novologix portal. You can access Novologix through the single sign-on access from My Insurance Manager using the member s ID.

Featured Webinars: Web Tools and Provider 101 Employee Prescription Drug Program On Jan.

The program requires employees and their dependents to receive a 90-day prescription for any long-term (maintenance) medication for a chronic condition.

CVS is a division of CVS/caremark, an independent company that provides specialty pharmacy services on behalf of BlueCross and BlueChoice.

4 Featured Webinars: Web Tools and Provider 101 Employee Prescription Drug Program On Jan. 1, 2017, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan implemented a new prescription drug program for their employees called Maintenance Choice. The program requires employees and their dependents to receive a 90-day prescription for any long-term (maintenance) medication for a chronic condition. They may also choose to receive their medication by mail or pick up their prescription at a CVS pharmacy. CVS is a division of CVS/caremark, an independent company that provides specialty pharmacy services on behalf of BlueCross and BlueChoice. What you should do: At the time of refill, most members will need a new prescription instructing the pharmacy to dispense a 90-day supply. If a member chooses to continue to fill his or her maintenance prescription at a pharmacy other than CVS, the plan will not pay for it. To view the notice that our employees received regarding this pharmacy benefit change, find this article in the Provider News sections of and In April, we are offering two online training courses. See dates and times listed to join us. First, in the Web Tools presentation, you ll learn about online resources and provider self-service tools available to help you get the information you need faster. Tuesday, April 4, 2017 noon (approximately one hour) Then, we present our newest educational session, Provider 101. This training will inform new providers, as well as established providers who need a refresher, about the responsibilities of a network provider, how to use our provider tools, and the role Provider Relations and Education plays in advocating for providers. Thursday, April 27, 2017 noon (approximately one hour) Next month, our featured webinar is Affordable Care Act. Register for any online training at on the Provider Training page.

5 Important Reminders... Stay tuned for upcoming information about medical record reviews in support of Risk Adjustment Validation. The Centers for Medicare & Medicaid Services (CMS) requires annual verification of the completeness and accuracy of diagnosis codes reported for your patients. When you receive a notice to send member records for medical review, please return those medical records to the Plan or department that requests them, in order to avoid delays. Don t forget to complete your Medicare Advantage compliance trainings and attestations by April 1. The following provider manuals are now available on our websites: 2017 BlueChoice Manual and 2017 Dental Manual. New FAQs for Specialty Drug Medical Benefit Management have been added to the Specialty Medical Drugs page of the provider websites. Three new providers have been added to the BlueCross, BlueChoice and Avalon participating laboratories list: CSI Laboratories; Invitae Corporation Laboratories; and Natera, Inc. Visit the Lab Precertification page of the provider websites for the complete list of participating labs. Be advised of a new denial code, UM902 Procedure/ Service/Item, is non-covered based on the medical guidelines found under CAM Please respond in a timely manner to medical record requests in support of our HEDIS outreach. Remember that BlueCross and BlueChoice do not reimburse our providers for release of member health information. Work with your medical record vendors to release this information as a nonbillable event to our plans.

6 Have a question for Provider Relations and Education? Provider advocates are always eager to assist you. If you have a training request or inquiry, please contact your county s designated provider advocate by using the Provider Advocate Contact Form. You can also reach our Provider Education department by ing provider.education@bcbssc.com or calling Benefits Disclaimer: The information listed is general information and does not guarantee payment. Benefits are always subject to the terms and limitations of specific plans. No employee of BlueCross BlueShield of South Carolina or BlueChoice HealthPlan of South Carolina has authority to enlarge or expand the terms of the plan. The availability of benefits depends on the patient s coverage and the existence of a contract for plan benefits as of the date of service. A loss of coverage, as well as contract termination, can occur automatically under certain circumstances. There will be no benefits available if such circumstances occur. Publication Disclaimer: For educational and research purposes only. While the articles in this publication are derived from sources believed reliable, it is not intended to be professional health care advice. Every effort has been made to ensure that the information in this editorial was correct. We do not assume and hereby disclaim any liability for loss caused by errors or omissions in preparation and editing of this publication

for Providers Laboratory Prior Authorizations THE LAB EDITION BlueNewsSM

for Providers Laboratory Prior Authorizations THE LAB EDITION BlueNewsSM THE LAB EDITION BlueNewsSM for Providers December 2017 Common Laboratory Denial Reasons Latest Labratory Policy Updates Policy Spotlight Frequently Asked Questions Contacting Provider Relations Resources