Network Engagement Hot Topics
Health care is a dynamic industry and Wellmark is an equally dynamic company. To keep you updated on the most important changes that affect you, please check this page regularly.
Hot topics for January include:
Confused about BlueCard®?
Wellmark is pleased to announce a new BlueCard page dedicated to answering common BlueCard questions. As members travel outside their Blue Cross and Blue Shield service area throughout the year, trying to understand the BlueCard program and processes is not always an easy task. This page will provide you with information on identifying BlueCard members, checking eligibility and benefits, filing claims, as well as tools and resources to help you best serve BlueCard members. Check out this new Web page today to learn more!
Know when to start submitting claims
Wellmark network(s) effective dates have changed for providers credentialed by Wellmark and Wellmark’s Delegated Entities. The streamlined effective dates will make it easier for you to determine when you can begin submitting claims. To estimate your Wellmark network(s) effective date, refer to the table on page 4 of the December BlueInk.
Avoid delays on application submissions
Wellmark revised and introduced new applications and addendums in November 2014. Beginning January 1, 2015, Wellmark will no longer accept the old applications. Instead, any old applications received will be returned and unprocessed. Be sure you are using the current forms by visiting the Credentialing and Contracting page.
Become an expert on the credentialing and contracting process
Join us on January 14, 2015 to learn about recent updates to the credentialing and contracting processes. This webinar will focus on the new applications, change in network effective dates, and the improved provider change form. We also have a few tips to share which will improve your experience when using the Credentialing Submission Tracker. Register today!
Watch for new ID cards
Members may begin showing up to your office with a Blue RewardsSM ID card. Blue Rewards is a point of service (POS) tiered network benefit plan that offers members incentives for practicing healthy behaviors. Since the member cost-share for Blue Rewards plans varies depending on the provider selected, remember to check deductible and out-of-pocket maximum accumulations electronically or through the online Check Member Information tool. For more information, visit the Blue Rewards page.
Ensure smooth referrals for specialty care
Certain hospitals and medical facilities that have been recognized for their expertise in delivering quality health care are nationally designated by Blue Cross and Blue Shield companies as Blue Distinction Centers. Blue Distinction Centers are available for specialty care such as transplants, bariatric surgery, cardiac care, complex and rare cancer care, knee and hip replacements, and spine surgery. Some Wellmark groups offer a benefit differential with a lower patient cost share for certain specialty care services when performed at a hospital or facility designated as a Blue Distinction Center. Be sure to check the member’s benefits for each referral, if applicable.
Proton beam radiation therapy requires prior approval
For dates of service on and after February 2, 2015, proton beam radiation therapy will be added to the list of treatments, procedures, and services that require prior approval. On January 19, 2015, the Wellmark Authorization Table will be updated to allow authorization requests to be accepted via the Utilization Management Tool. To help you prepare for this transition, SmartSheetsTM have been made available. To access the SmartSheets, log in to Wellmark.com and look under ‘Utilization Management (UM) & Authorizations.’
BRCA testing? Prior approval required for Federal Employee Program (FEP) members
FEP now requires prior approval for BRCA testing for both preventive and diagnostic testing. For preventive BRCA testing, genetic counseling and evaluation services must be performed before the test. A list of services that require prior approval for FEP can be found on the Medical Policies and Authorizations page. For more information on the 2015 benefit changes, you can access the 2015 Service Plan Brochure on fepblue.org.