Transcript 2008 Provider Seminar - Blue Cross of Northeastern Pennsylvania

PROVIDER RELATIONS SEMINAR
October 8, 2008
1
Today’s Agenda
•
Welcome – Jeanne Wisnewski
•
Blue Health Plan Updates – Joe Malahowski
•
Navigating the BCNEPA Provider Center – Rebecca Zingaretti
•
EDI Tips – Rebecca Krasson
•
Medical Director Update – Dr. Thomas Curry
•
Blue Health Solutions – Wendy Faux
•
AllOne Mobile – Gerald Korea
2
Blue Health Plan
Updates
3
UPDATES
First Priority Health®
4
First Priority Health®
• Products:
– BlueCaresm HMO
– BlueCaresm HMO-Plus
– CHIP
– adultBasic
Alpha Prefix – YZH for all products
Provider Services – 1-800-822-8752
Member Services – 1-800-822-8753
5
6
7
8
9
First Priority Health - Billable Procedures Update
Added 5/13/08:
– Hemoglobin A1C Testing (83037)
Added 7/1/08:
– Rotarix (90681)
– Kinrix (90696)
– Pentacel (90698)
Added 9/1/08:
– Flu Mist (90660)
10
First Priority Health – Policy Updates
Recent Policy Updates:
PCP Office Freeze Policy Addition:
If a PCP provides services to a new First Priority Health member and
the practice is “frozen” or “closed” to new members, we will enroll
the patient with your practice upon receipt of a claim. By seeing the
patient, the PCP has taken responsibility for this member and agreed
to accept him/her into the practice. (Effective 12/01/08)
11
First Priority Health – Policy Updates
Authorization of Care Changes:
• 4 Nasal Surgery codes removed from the FPH Focus
Outpatient Precertification List
(30130, 31255, 31256, 31276)
• Home Health Therapy has been added to the services
requiring precert
12
First Priority Health – Policy Updates
Non-participating Provider Request Form
Changes:
• Eliminated the “Date of Appointment” field
• Revised form is available on BCNEPA Provider Center
13
First Priority Health – Benefit Changes
• What Products Are Affected?
BlueCare HMO and BlueCare HMO Plus Group Products
that currently include a deductible and co-insurance
• When are the changes effective?
Effective with group renewals beginning 01/01/09
14
First Priority Health – Benefit Changes
Today, deductible and/or co-insurance apply to the following:
• Inpatient hospital services
• Inpatient hospice services
• Inpatient mental health services
• Inpatient substance abuse services
• Detoxification services
• Skilled nursing care services
• Outpatient surgery services
15
First Priority Health – Benefit Changes
Effective with group renewals beginning 1/1/09, deductibles
and/or co-insurance will be applied to all services except:
– Emergency care and ambulance
– Childhood/adult immunizations
– Allergy extracts/injections
– Routine screenings: gyn exam, pap smears, mammography,
colon cancer and prostate exams
– Outpatient laboratory/radiology services
– Outpatient visits (includes mental health)
– Bony-impacted teeth
– Nutritional therapy
16
First Priority Health – Claim Submission
Hardcopy Claim Submission:
BlueCare HMO
PO Box 69699
Harrisburg, PA 17106-9699
17
First Priority Health – Claim Submission
Electronic Claims
1.) Register as an electronic biller
www.bcnepa.com/EDI/registrationForm.aspx
2.) Submissions through Emdeon use payor code 23241
OR
Submit with the payor code assigned to First Priority Health
by your clearing house
18
UPDATES
First Priority Life
Insurance
sm
Company
(FPLIC)
19
First Priority Life Insurance Company
Product
Prefix
BlueCare PPO
QFG
BlueCare PPO Qualified High Deductible (QHD) Health Plan
QFG
BlueCare PPO Individual Conversion
QFC
BlueCare Direct
QFD
BlueCare Direct Advantage (Previously BlueCare Direct QHD)
QFD
BlueCare Traditional
QFT
BlueCare Comprehensive
QFM
BlueCare PPO Custom Groups
AUV, EBU, NNU, NTJ,
NTQ, SNQ, SVQ
BlueCare Direct Select (Individual product, available 1/1/09)
QFD
BlueCare Direct Essentials (Individual product available 1/1/09)
QFD
BlueCare EPO (Group product available 1/1/09)
QFI (In-area resident)
QFO (Out-of-area resident)
20
21
22
23
24
First Priority Life Insurance Company
25
First Priority Life Insurance Company
BlueCare Direct Select & BlueCare Direct Essentials
• Individual Products Available 1/1/09
• Medically Underwritten
• Deductible and co-insurance apply
• Physician Network – FPLIC PPO Network
• Hospital Network – BlueCross PPO Network
• Ancillary Network – BlueCross
• Focus Precert In-area; Full PAC Out-of-area
26
First Priority Life Insurance Company
27
First Priority Life Insurance Company
28
First Priority Life Insurance Company
BlueCare EPO – In-area Resident (“QFI”)
•
Highest benefit level paid for services obtained from the FPLIC EPO network
•
EPO Network is FPLIC PPO network plus some providers in the Lehigh Valley
and Berwick areas
•
Except for emergency services, no benefits for services provided by non-par
providers within the 13 county area
•
Lower tier benefit for services provided outside the 13 county region, when
provided by a BlueCard PPO provider
•
Member resides within the 13 county servicing area (“QFI” Alpha Prefix)
29
First Priority Life Insurance Company
30
First Priority Life Insurance Company
BlueCare EPO - Out-of-Area Resident (“QFO”)
•
Highest benefit level paid for services provided from any BlueCare EPO EPO network
provider
•
Highest benefit level paid for services provided from any BlueCard PPO provider for
services outside the 13 county area
•
No benefits for services provided by a non-par provider, except for emergency services
•
Member’s residence is outside the 13 counties (“QFO” Alpha Prefix)
31
First Priority Life Insurance Company
32
First Priority Life Insurance Company
Provider Administrative Appeals Policy
• Must be submitted within 90 days from the date on the Remittance
Advice
• Administrative appeals include:
– Denials for timely filing
– Questionable level of payment
– Failure to obtain the necessary prior authorization for non-emergency
services
33
First Priority Life Insurance Company
Send Written Facility Appeals to:
FPLIC Appeals
Provider Relations Department
19 North Main Street
Wilkes-Barre, PA 18711
34
First Priority Life Insurance Company
Send Written Professional Appeals to:
FPLIC Appeals
Medical Policy Department
19 North Main Street
Wilkes-Barre, PA 18711
35
First Priority Life Insurance Company
Auto-posting is now available for providers
whose FPH or FPLIC claims pass through
McKesson or Emdeon.
• Contact your clearinghouse for specific instructions
• Print the auto-posting template from the “Forms” section on the BCNEPA
Provider Center
• Copy the template onto your office’s letterhead
• Complete all fields on the form
• Fax completed form to: EDI Services (570) 200-1700
36
First Priority Life Insurance Company
Billing Information: Electronic Claims
1.) Register as an electronic biller
www.bcnepa.com/EDI/registrationForm.aspx
2.) Emdeon Utilized-submit FPLIC claims to BCNEPA using
payor code 23241
• All others-submit with the payor code assigned by your
clearing house for FPLIC
37
First Priority Life Insurance Company
Paper Claim Billing Information
BlueCare Claims
PO Box 890179
Camp Hill, PA 17089-0179
(Alpha Prefixes: QFC, QFD, QFG, QFI, QFM, QFO, AUV, EBU, NNU, NTJ, NTQ,
SNQ, SVQ)
38
First Priority Life Insurance Company
Common Claim Rejections
• Professional Providers:
S5002 “Coverage was cancelled prior to the date of service.
Therefore no payment can be made.”
• Reasons:
– Incorrect or missing alpha prefix
– Electronic claims sent to incorrect payer
– Paper claims sent to incorrect address
39
First Priority Life Insurance Company
Common Claim Rejections
• Facility Providers:
PR27 “PR Patient Responsibility/27 expenses incurred after
coverage terminated.”
• Reasons:
– Incorrect or missing alpha prefix
– Electronic claims sent to incorrect payer
– Paper claims sent to incorrect address
40
UPDATES
HIGHMARK BLUE
SHIELD
41
Highmark Blue Shield Updates
• NDC Information Requested on Medical Benefit
Drug Claims (Special Bulletin July, 2008)
• New Drugs Added to Self-administered Injectable
or Oral Biotechnology Drug Program (Special Bulletin
June, 2008 Effective 10/6/08)
• Codes Added to List of Procedures Requiring
Authorization (Special Bulletin June 20, 2008, Effective 10/1/08)
42
Highmark Blue Shield Updates
Flu Season Reminder
• Age range expanded to include all children from 6 months to
19 years of age.
• Provider Bulletin 2007-0122-W provides detailed billing
instructions
43
Highmark Blue Shield Updates
Billing Information
Electronic Claims:
Highmark Blue Shield 1-800-992-0246
www.highmarkblueshield.com
Provider Center
Electronic Data Interchange (EDI)
44
Highmark Blue Shield Updates
New Electronic Initiative: Eliminate Paper EOB’s
• You may request electronic EOB’s if you:
– Are electronically enabled
– Are enabled with Electronic Funds Transfer (EFT)
– Are Navinet enabled
– Receive Electronic Remittance Advice (ERA)
• Provide the following information to your Provider Relations
Consultant:
– Name
– Billing NPI
– Date you wish to stop receiving paper EOB’s
45
Highmark Blue Shield Updates
Billing Information – Paper Claims
Highmark BlueShield Claims (Alpha Prefix ZAT, ZAS)
PO Box 890179
Camp Hill, PA 17089-0179
FreedomBlue Claims (Alpha Prefix FER, HKR)
PO Box 890170
Camp Hill, PA 17089-0170
46
Highmark Blue Shield Updates
Billing Information – Paper Claims
Federal Employee Program (ID # Starts with “R”)
PO Box 898854
Camp Hill, PA 17089-8854
BlueCard Claims
PO Box 890062
Camp Hill, PA 17089-0062
47
Highmark Blue Shield Updates
Changes in Billing Information
• Assignment Account Add/Delete form has been updated. The
old form will not be accepted after 10/1/08
• For electronic billing via a direct connection, changes made
to tax ID#, billing name, etc. require that you update your
Trading Partner Agreement
– EDI Services 1-800-992-0246
48
Highmark Blue Shield Updates
Electronic Claim Edit
Effective 9/12/08
• Tax ID/NPI combination on claim does not match
tax ID/NPI combination on provider file
• Rejection Codes:
– Category Code:
A8 “Rejected for relational field in error”
– Claim Status Code: 128 “Entity’s tax ID”
562 “Entity’s NPI”
49
Highmark Blue Shield Updates
New Payor ID Edit
• Scheduled for implementation 11/7/08
• Alpha Prefix will be cross-matched to Payor ID
• If matched, claim will be accepted
• If no match, claim will be returned with the following denial:
“The claim has been submitted with the incorrect payor ID.
Please resubmit the claim with the correct payor ID.”
50
Highmark Blue Shield Updates
Medicare Advantage Plans
• FreedomBluesm PPO
FER
• FreedomBluesm PFFS
HKR
51
Highmark Blue Shield Updates
FreedomBlue PPO
• Medicare Advantage PPO
• Contracted Professional Facility and Ancillary Network
• Medicare Fee Schedule
• Medicare Medical/Payment Policy
• Privileging Required for Diagnostic Testing
• Expansion in 13 Counties Underway !!!
52
Highmark Blue Shield Updates
FreedomBlue PFFS
• Non-network plan-no formal contracted providers
• Medicare Fee Schedule Allowances
• No Plan Deductible
• Inpatient, outpatient, office copays and/or coinsurance may
apply
53
Highmark Blue Shield Updates
FreedomBlue
Billing for SNF levels:
Level 1 = Revenue Code 0128
Level 2 = Revenue Code 0200
Level 3 = Revenue Codes 0120
Highmark Blue Shield’s system must find a match between the level of care
authorized by HMS and the revenue code submitted by the facility for
the inpatient care. Claims on which the revenue code does not match
the assigned level of care will be rejected.
54
Highmark Blue Shield Updates
BlueCard® Improvement Initiatives
OBJECTIVE: Improve Provider & Member Satisfaction with BlueCard
• Plan to Plan Servicing
• Claim Timeliness
• Provider Satisfaction Measure
– Telephonic Interviews
55
Highmark Blue Shield Updates
Do you know:
• How to verify BlueCard eligibility?
• How to file a BlueCard claim?
• How to obtain BlueCard claim status?
• Who to contact for BlueCard claim issues?
If you answered “No” to any of these questions,
contact your Provider Relations Consultant.
56
UPDATES
BlueCross of Northeastern
Pennsylvania
57
BlueCross of NEPA Updates
Joint Products with Highmark Blue Shield:
• BlueCare® Cooperative (Non-group)
YZR-ZAT
• BlueCare Student
YZR-ZAT
• Special Care
YZR-ZAT
• BlueCare Senior
YZM-ZAS
• BlueCare Security
YZM-ZAS
58
BlueCross of NEPA Updates
Policy Updates:
• CDR Associates – Credit Balance Recovery Vendor
– Replaces AIM
– Notification Letter sent 4/27/08 (CFO or Patient Accts Director)
• Present on Admission (POA) Indicator
– Required effective 4/1/08 for all products
– Required on all primary & secondary diagnoses
– Required for all acute hospital admissions
• New Tier Zero Prescription Plan
– Effective 7/1/08
– Includes 65 “best buy” generic medications
59
BlueCross of NEPA Updates
• Electronic Adjustments
– Please use for all lines of business
• Claim Reconsideration Form
– Form revised 5/1/08
– Request payment reconsideration of fully or partially denied
institutional claims
– Mail or fax to claims department
• Review Process for DRG is Simplified
– Initial certification for I/P admissions still required
– Further clinical updates not required unless admission exceeds 14
days
– Change does not impact retrospective review of cases
60
BlueCross of NEPA Updates
• UB Acceptance/Rejection Report Changes
– Based on your feedback
– Combined into 1 report
– Effective 10/27/08
– Sort order:
• All Rejected Claims
– Alpha order by prefix, then by patient last name
• All Accepted Claims
– Alpha order by prefix, then by patient last name
– Located on Navinet
• Facility Report Drop Down
–
“BlueCare Acceptance Rejection”
61
BlueCross of NEPA Handouts
• Updated Precert Lists
– BC, FPLIC
• 2 New ICD-9 Procedure Codes Added
• New ICD-9 Diagnosis Code Ranges
– EPO List will be published in November Bulletin
• Updated Alpha Prefix List
• Updated Telephone Directory
62
Navinet Updates
• FPH Eligibility & Benefits Inquiry Enhancements
– Visit Limit Accumulators
– $$$ Limit Accumulators
– Used and Available Totals
• BlueExchange Eligibility & Benefits Inquiry Enhancements
– Visit Limit Accumulators
– $$$ Limit Accumulators
– Used and Available Totals
63
Navinet Updates
Coming Soon:
FPH Non-participating Provider Request Entry Available January 2009
•
Same data requirements as the paper form
•
Search for a Provider function
•
Create a Provider function
•
An authorization number will be assigned beginning with “N”
FPLIC Benefit Accumulator Information
64
Navinet Updates
Highmark Blue Shield
– EOB’s/Remittance Advices bearing the BCNEPA logo:
• No longer viewable in Highmark’s Navinet
• Paper EOB’s/Remittances will be produced and mailed
– Bank Account Numbers
• Removed from:
– Paper Remittance Advice
– Navinet Remittance Advice
– Explanation of Benefits
– Electronic Funds Transfer Notices
65
REMINDER
Annual Provider Satisfaction Survey Is Coming!
• We value your feedback and comments
• We use that feedback to make changes and improvements
• Please watch the mail and when the survey arrives, please
take a few moments to complete it.
66
QUESTIONS?
67
BCNEPA Provider Center
Rebecca Zingaretti, Provider Relations
EDI Tips
Rebecca Krasson, EDI Services
Code Descriptions
•
A3 – This is the Claim Status Category Code which states “Acknowledgement/Returned as
unprocessable claim – The claim/encounter has been rejected and has not been entered into
the adjudication system.”
•
130 – This is the Claim Status Code which states the error is with the “Entity’s Blue Shield
provider id.” The description has not been updated to include the NPI.
•
85 – This is the Entity code which indicates Billing Provider.
–
41 = Submitter
82 = Rendering Provider
–
71 = Attending Physician
DN = Referring Provider
–
72 = Operating Physician
IL = Insured or Subscriber
–
77 = Service Location
PR = Payer
QC = Patient
All of these codes can be found on the Washington Publishing Company website:
http:/www.wpc-edi.com
70
71
72
73
74
Top 5 First Priority Life Insurance Rejections
• A3 – 130/77 Entity’s Blue Shield provider id.
• A3 – 138/77 Entity’s site id.
• A3 – 145/85 Entity’s specialty/taxonomy code.
• A3 – 26/85 Entity not found.
• A3 – 33 Subscriber and subscriber id not found.
75
Top 5 First Priority Health Rejections
• E33E – Invalid NPI/Tax ID/Taxonomy code combination
• E01C – Incorrect Member ID
• E02C – Incorrect patient first name
• E02D – Incorrect patient last name
• E03C – Incorrect patient date of birth
EDI rejections are listed in the 2007 Provider Bulletins for January,
February, May, September, October and November
76
Auto Posting
•
This feature is now available for providers whose clearinghouse is McKesson or
Emdeon. Navinet currently has this functionality.
•
Contact your clearinghouse to initiate the process.
•
A letterhead template has been created and is available on the BCNEPA Provider
Center/Provider Relations/Forms. You may also call 1-800-451-4447 to request
a fax copy.
•
Please fax the completed form to EDI Services at 570-200-1700.
77
MEDICAL DIRECTOR UPDATE
Thomas A. Curry, M.D.
Medical Director Network Management & Provider Advocacy
Overview of Clinical Advocacy
• Medical Director’s Office
• Helpful comments/suggestions from:
– Medical Management
– Quality/Credentials
– Medical Policy/Review
Medical Director’s Office
• Serves at the interface of Health Plans & Practitioners
• Quality programs and issues
• Coverage determinations
• Claims payment concerns
80
Medical Director’s Role
• Direct contact with providers to discuss clinical issues
• Educate physicians regarding health plan policies and
procedures
• Assist in the optimal use of patient’s benefits
81
Medical Director’s Role
• Understand medical necessity definition of the health
plan
• Understand the rules regarding coverage
• Determine when criteria should be set aside due to
special clinical circumstances
82
Medical Director’s Role
• Provide advice to health plan administration regarding the
medical appropriateness of new technologies and additional
benefit provisions
• Develop medical policy
• Direct work of clinical quality committees
83
Medical Director’s Office
• Chief Medical Officer
• Senior Medical Director
• Medical Director – Quality
• Medical Director – Provider
• Associate Medical Director - UM
Phone number 1-800-462-0900
Leo M. Hartz, M.D., MHM
•
•
•
•
•
•
•
•
Penn State University
George Washington U.
Medical School
Williamsport Hospital
FP Residency
20 years experience as FP
FP Residency Program Preceptor
Past President Lycoming Co.
Medical Society
Past President Pa Acad FP
Chief Medical Officer
85
Stephen A. Rothstein, M.D.
• The Citadel,
• Medical University of
South Carolina
• Emergency Medicine
• Hospice Medical Director
• Hospital Chief of Staff
Ethics Committee
• Medical Director-Cigna
• Senior Medical Director
•
Account Advocacy
•
UM
86
Joseph C. Koval, M.D.
•
•
•
•
•
•
•
Georgetown University
Letterman Army MC
Walter Reed AMC
Internal Medicine
Pulmonary and
Critical Care
Leadership in County
Medical Society
Faculty Scranton/Temple
Residency Program
Member Advocacy
and Quality
87
Thomas A. Curry, M.D.
• St. Joseph’s University
• University of Penn Med
• Childrens Hospital, Phil.
• Pediatrician
• 20 years private practice
• 8 years Medical Director
• Medical Director
Network Management
and Provider Advocacy
88
Neil Lesitsky, M. D.
• Albright College
• Hahnemann University
• Family Medicine
Hamot Medical Center
• Family Practice 20 years
• Past President PAFP
• Preceptor FP Residency
89
Medical Management
• Benefit determination versus medical necessity
determination
•
Prior Authorization –steps to reduce administrative
challenges
Benefit Determination
• Benefit issues revolve around the contract between the health
plan and the employer or subscriber
– Group or Individual Master Contract
– Contract riders
– Benefit handbook
91
Benefit determination
– Determined by the health plan
– Determined by employer groups
– Mandated by state or federal laws or regulations
– Optionally purchased by plan member (patient)
92
Benefit Determination
• Description of what is covered
– May include specific circumstances required
– May have limits
• List of benefit exclusions
– Services not covered in any circumstance
Medical Director does not have the ability to change the
benefit.
93
Prior Authorizations
• The unique circumstances for a non-par referral should be
part of initial request and incorporated into the physician’s
notes
• A detailed physical examination of the area in question
recorded on the chart is needed as part of evaluation of MRI
request
94
Credentials
The credentialing department works with questions related to:
 Credentialing documents
 Questions about practice expansion
 Status of application
 Clarification on requirements for Premier Blue
 Questions related to credentialing issues, call Diane Jones at 570200-4396
95
Quality
• Education by provider and provider’s staff is key to
identifying barriers for non-compliant patients and
improving their adherence to guidelines.
• Quality staff is available as resource in promoting preventive
screenings.
96
Medical Policy/Review
• Medical policies are available on line at Provider center and
updated monthly
• Documentation submitted for review should pertain to the
code under question. For unlisted codes indicate the service
or procedure billed along with the clinical notes.
97
Member Appeals
• If a member receives notice of denial of a service, the
member needs to contact the Service Representative number
on their insurance card to initiate the appeal process.
• Insurance regulations preclude our acceptance of a member
appeal initiated by their provider without the member’s
written consent.
• After the member has initiated the process, our staff will
contact your office to provide the necessary information and
documentation of unique circumstances in the case.
98
Blue Cross of Northeastern Pennsylvania
“Your Health is Everything. To Us”
99
BlueHealth Solutions
Wendy Faux
101
What is Blue Health SolutionsSM?
Blue Health SolutionsSM is a comprehensive personalized health and
wellness program with the unique ability to proactively identify
individuals at risk for future health problems, so we can take action
today—before they become high cost
– It is made up of two key components:
• Population health management through a high tech/high touch system
– Improved care management of members
– Better identification of future high cost members
• Incentive tools – to incent behavior while maintaining confidentiality
– Employer customized programs
102
We help members at every level of need
• We address the full continuum of health needs of your group by customizing
programs for each individual based on their level of risk
• Each member’s care is managed by one Clinical Professional to ensure consistency
and build relationships which increase participation
Low
Risk
Healthy
Acutely Illness
Chronic Illness
Catastrophic
High
Risk
Health Coaching, Wellness Programs, Prevention
On-line Portal: Patient Education, Information Gathering, Information Sharing
Intermediate Care Programs
Disease Management Programs
Transition of Care
Catastrophic Case Management
103
104
MyHealth Manager
• Health, lifestyle and care management programs
• Offers telephonic education and support from a Care Coordinator who is a
health care professional, including registered nurses
• Available 8:00 am to 8:00 pm
• The key components of each program include
– individualized educational materials and self-management tools
– telephone monitoring by the Care Coordinator as needed
– support between physician office visits
– coordination of physician’s treatment plan
105
MyHealth Manager - Programs
Lifestyles – Health Coaching
– Exercise, nutrition, stress, cholesterol
Disease Management
– Pregnancy
– Diabetes
– Asthma
– Depression
– Coronary Artery Disease (CAD)
– Chronic Obstructive Pulmonary Disease (COPD)
– Congestive Heart Failure
– Low Back Pain
– Weight Management
– Smoking Cessation
Intermediate Care Management
– Cancer, Multiple Sclerosis, Rheumatoid Arthritis, other intermediate needs
Large Case Management & Transition of Care
– Support, Education and follow up for complex care and coordination of services
106
Web Tools - MyHealth Solution
•
•
•
•
•
•
•
MyHealth Solution has and is one of the
most comprehensive health information
resources available online
Uses the latest health information and
interactive wellness tools including
quizzes, health calculators and health
assessments
Includes a personal health assessment (HA)
to help understand health history and the
impact it may have on future health
Health Assessment
– Scores are integrated into the
predictive modeling system
– Care Coordinators can access
responses
Customized home page based on HA
results
Targeted subject matter is “pushed” based
member’s health risks
Personal Health Record (PHR) to maintain
health records, track doctors' appointments
and even send email reminders
107
MyHealth Mobile
• Mobile Personal Health Record
–
–
–
–
Allergies
Prescriptions
Health Benefits
Physician Contacts
• Health Reminders
• Fax health history to a physician through
your phone
• Leading security features
• Password protected
108
MyHealth Coach
•
24/7 phone access to professional Health Coaches
•
Online Live Chat - 24/7 online access to the coaches through MyHealth
Solutions web site
•
Registered nurses and health care professionals who can answer questions about
health issues
•
Allows members to make informed decisions about their health
109
MyHealth Mart
•
•
•
•
Value-added discount program promotes better health and well-being
Discounts on a variety of health-related products and services
Exercise, nutritional counseling, herbs, yoga and numerous other offerings are
all included for members in this program
Discounts on “non-covered services” such as alternative health services such
as martial arts, aromatherapy, massage therapy, fitness centers and weight
management programs
110
Member Engagement
Standard for all BCNEPA members:
• Periodic mailings and advertising to promote Blue Health Solutions
• Direct outreach moderate and high risk members identified through claims for
enrollment into the programs
Customized for a company:
• Worksite Engagement – Customized to you with your Client Engagement
Coordinator
– Research- what works for you? What have you done, what is your worksite
environment, what are your goals?
– Design- an employee incentive program that fits your company to engage employees
and set mutual engagement goals to measure success
– Implement- customized engagement outreach for your population
• onsite to explain the program and help members register and take their on-line
Health Assessments
• supporting employee communications- mailings, posters, newsletter articles, etc.
– Report- monthly participation reports for you to administer their incentive, and track
engagement levels
111
Member Engagement - The experience
The experience for members and their families is guided by three principles:
1. Confidentiality
–
–
–
–
2.
Creativity
–
–
3.
Information collected in the course of the Wellness initiative is held in strict
confidence
All systems are HIPAA compliant
Health related reporting is provided in aggregate
Engagement reporting is based on activity, not health condition.
Our Care Coordinators work to find ways to help people make difficult
behavioral changes
The Client Engagement Coordinator helps reach out to individuals at the
workplace with engaging activities and interactions
Clinical professionalism
–
–
All of our Care Coordinators are trained clinicians using appropriate behavioral
techniques
Where an existing physician relationship is in place, our personnel enhance never supplant - the current practitioner
112
In Summary
• Blue Health Solutions uses integrated systems that combine:
–
–
–
–
–
Predictive modeling
Claims data
Pharmacy data
Online health assessment
Member web portal usage
• Covers entire spectrum of health including wellness, disease management,
care management and catastrophic case management
• Actively engages members to increase participation
Getting the most out of Blue Health Solutions
113
Questions and Answers
114
page 115
Secured by Diversinet
What is AllOne Mobile?
Secure, mobile access to health
information, anytime, anywhere.
page 116
Secured by Diversinet
Why did we create AllOne Mobile?
Health information is an individual’s least
accessible critical information store
Enhanced, secure, health information
communication will facilitate health and
wellness outcomes
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Secured by Diversinet
AllOne Mobile’s Core Tenants
It must be secure
It must be controlled by the individual
It must be intuitive
It must be agnostic
It must be affordable
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AllOne Mobile Security
Mobile Wallet
Vault
Server Authenticates Device/User
Encrypted Data in Transit
Secure Tunnel
Mobile Authenticates Server
PIN Protected
Data Encrypted
Bi-Lateral Authentication
Roll-Based Access
Data Encrypted
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AllOne Mobile Example Information Flow
Care Manager
Direct
Direct
Guest Access
Provider
CCRg
CCRg
Wallet
Email*
XML
CCR
Vault
FAX
SMS/IVR/IM
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Emergency
Assistance
Pharmacy/Lab/
Radiology
Other resources
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Easy Menu
Card Driven
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Summaries
Elements
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Messages
Messages/Alerts
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Guest Users – Web Access
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7x65
Dependents
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Sharing
Sharing Options
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Thank You For Coming!
Please help us by completing the evaluation form in your
packet. We value your comments and suggestions.
Enjoy the rest of your day
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