As ICS members are probably aware, Blue Cross Blue Shield of Illinois (BCBSIL) has begun implementation of its utilization management program requiring many providers to obtain preauthorization for physical medicine services. BCBSIL has classified providers into “tiers” requiring various levels of preauthorization and has contracted with OrthoNet to review provider requests for preauthorization.
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In 2013 and 2014 there will be many changes in the healthcare field. Some of the changes include mandatory reporting of PQRS, Affordable Care Act, ICD-10 CM diagnosis codes, and the new 1500 Health Insurance Claim Form. My articles over the next year will concentrate on these changes and how they affect chiropractic physicians. In this article, I am going to answer questions pertaining to the new 1500 HealthInsurance Claim Form.
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The American Chiropractic Association announced yesterday that effective January 1, 2014, the BCBS Federal Employee plan will “now cover any licensed medical practitioner for covered services performed within the scope of that license, as required by Section 2706(a) of the Public Health Service Act (PHSA).”
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This weekend I had the honor of attending the Congress of Chiropractic State Associations in Seattle, Washington along with board members and executive directors of many of the state chiropractic associations and national chiropractic organizations. In addition to meeting and networking with leaders of our profession, our Executive Director Marc Abla and I attended multiple roundtables and listened to several educational speakers.
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When I offer non-therapeutic (relaxation) massages or other non-medical services in my office, should I provide patients with a disclaimer? What should be included in a disclaimer?
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The relationship of in-network providers and BCBSIL is governed largely by the provider agreement you signed when you joined the network, and as BCBSIL has amended periodically. The Provider Manual and BCBSIL medical policies are also included in the agreement.
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Illinois allows for new licensure through two different methods: Acceptance of Exam and Endorsement.
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BCBSIL has indicated that tiering would be based on a number of visits per patient. Keeping in mind our limited sample, the data we collected does indicate that per-patient visit averages were the key indicators. However, the correlation is not perfect. The overall problem is the lack of participation from Tier 1 doctors.
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