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Essential resources for those who
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Last updated Wednesday, February 26, 2014
- Attention Hospitals: ICD-10 Spanning Dates of Service Learn more » (2014-010 - Posted 2/26/2014)
- Update – Blue Advantage Member Condition Tracker Information
Providers who wish to dispute open condition gaps may now access the Member Condition Tracker Disputes Review Form by logging into ProviderAccess. The form is located underneath the "Blue Advantage Primary Care Incentive Program" heading. Send the completed dispute form via fax to 1-205-220-0483 or 1-855-587-9307. In addition, a Member Condition Tracker Frequently Asked Questions (FAQ) flier is now available through ProviderAccess. This flier is also located underneath the "Blue Advantage Primary Care Incentive Program" heading. Please contact your Provider Network Services Representative at 1-866-904-4130 if you have any questions. (Posted 2/26/2014)
- 2014 Healthcare Effectiveness Data Information Set (HEDIS®) Medical Review Program
Blue Cross and Blue Shield of Alabama would like to request your assistance in completing the 2014 HEDIS medical review program. HEDIS data collection and reporting is mandated by the Centers for Medicare & Medicaid Services (CMS) for Medicare Advantage plans. Blue Cross has contracted with Inovalon, Inc. (formerly MedAssurant, Inc.) to facilitate our medical record review. An in-depth letter explaining the process for the medical review program is forthcoming. Providers may contact your Provider Network Services Representative at 1-866-904-4130 or the Inovalon Provider Relations Department at 1-301-809-4000, option 2, with any questions. (Posted 2/26/2014)
New and Updated Coding Guides Available Through ProviderAccess
For your reference, new Coding Guides are available. These new guides reflect (in blue) ICD-9 codes that the Centers for Medicare & Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) recognize as mapping to Hierarchical Condition Categories (HCC). The CMS-HCC risk-adjustment models are used to calculate risk scores which predict individual beneficiaries' healthcare expenditures, relative to the average beneficiary. Below is a list of the new and updated Coding Guides available. Look for the "Coding Guides" heading located near the bottom of the Web page.
- Autoimmune and MS
- Chronic Kidney Disease (CKD)
- Coagulation Defect/Hemophilia
- COPD and Asthma
- Mental/Nervous Disorders
- Neuro-Quadriplegic and Paraplegic
- Reminder – Member Condition Tracker Disputes
At this time, the Member Condition Tracker condition gap disputes process is only available for Blue Advantage members (MBG prefix). The Member Condition Tracker is for educational purposes only for all other members. If you have any questions, contact your Provider Network Services Representative. (Posted 2/26/2014)
CPT codes, descriptions and other data only are copyrighted © 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
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