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WELCOME TO NEWS FROM BLUE,SM CREATED TO HELP YOU BETTER MANAGE YOUR HEALTH PLAN BY KEEPING YOU UP-TO-DATE ON THE LATEST INFORMATION FROM WELLMARK BLUE CROSS AND BLUE SHIELD. NEWS FROM BLUE WILL BE E-MAILED TO YOU MONTHLY, AND IS ALSO ARCHIVED ON WWW.WELLMARK.COM.
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New Pharmacy Program Starts July 1
Wellmark Blue Cross and Blue Shield is launching Pharmacy Insights,SM a new program to manage the pharmacy component of medical spend. As part of Pharmacy Insights, Wellmark is transitioning administration of prescription drug benefits July 1 to Catalyst Rx. Catalyst Rx contracts with more than 55,000 pharmacies throughout the United States, a comparable network to other national pharmacy benefit management companies.
Details of the Catalyst Rx Transition
Much of the transition process to Catalyst Rx will be transparent to you and your employees. Catalyst Rx has significant experience and a very successful track record in transferring pharmacy programs. Here’s a quick look at the transition steps and information your employees who have pharmacy benefits through Wellmark can expect.
NEW ID CARDS
The biggest change for employees is new ID cards — scheduled to mail in late June, along with information explaining why they are receiving a new card, transition details, and instructions on how to order additional cards. Employees should begin using the new ID cards on July 1. Along with their ID card, employees will receive a pharmacy amendment to their benefits certificate.
NEW MAIL ORDER SERVICE
Walgreens Mail Service is Wellmark’s new mail service provider starting July 1. All active mail order prescriptions will transfer to Walgreens. Physicians should not need to submit another prescription to Walgreens Mail Service. As with any prescription transfer, members must initiate the refill prior to receiving the medication. A small percentage of medications will not transfer, such as controlled substances and compound medications, and a new prescription will need to be sent to Walgreens Mail Service. If an employee has used
the mail order program in 2006, they’ll receive enrollment information in the mail in June to help them with this process.
PRIOR AUTHORIZATION
Catalyst Rx will load all prior authorizations currently on file into its system, enabling employees to fill prescriptions for drugs requiring prior authorization starting July 1. A new prior authorization will not be needed.
CLAIMS FORMS
Drug claims are filed electronically on employees’ behalf when they show their Wellmark ID card at a network pharmacy. If a paper claim does need to be filed, your employees can download new drug card and Comprehensive Major Medical (CMM) claim forms from www.wellmark.com starting July 1. |
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Contact your Wellmark account team for more information on Pharmacy Insights.
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New Private Member Online Services
We’re making it easy for your employees to manage their health — and their health care benefits with myhealth@wellmark Private Member Online Services. Starting July 1, employees can visit www.wellmark.com, login with their member ID and password, and get member-only access to “real-time” answers and information, including:
- BlueConnection® Health Plan Tools — Access to health plan benefit information 24-hours-a-day, seven-days-a-week.
- BlueConnection® Pharmacy Tools — Keep track of prescriptions, check on drug interactions, locate a pharmacy, and view the Wellmark drug list for lower-cost prescription alternatives.
- HealthyLiving Powered by WebMD® — Read thousands of articles, plus subscribe to a variety of health- and disease-specific e-newsletters.
- Walking Works® — Tools that promote better health through exercise and weight control, including an online Activity Tracker that allows monitoring of daily physical activity.
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Watch for information about myhealth@wellmark worksite promotional materials in the July issue of News From Blue.
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Wellmark Health Plan of Iowa Grows Even Stronger
Twenty-one counties were recently added to the Wellmark Health Plan of Iowa service area, greatly expanding the availability of Wellmark’s lower cost managed care products: Blue Choice,® Blue Access,SM and Blue Advantage.® The Wellmark Health Plan of Iowa network now includes 66 of the state’s 99 counties, encompassing 88 percent of physicians and 96 percent of hospitals in the state.
NEW WELLMARK HEALTH PLAN OF IOWA COUNTIES |
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| Adair |
Fremont |
Page |
| Adams |
Greene |
Pocahontas |
| Audubon |
Hamilton |
Poweshiek |
| Buena Vista |
Hardin |
Sac |
| Calhoun |
Harrison |
Taylor |
| Carroll |
Humboldt |
Webster |
| Decatur |
Montgomery |
Wright |
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Contact your Wellmark account team about offering a Wellmark Health Plan of Iowa product to your employees.
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Important Notices for Your Employees
Notice of our Information Privacy Policies and Practices is in compliance with The Gramm-Leach-Bliley Act of 1999. Wellmark is obligated to protect the security and confidentiality of personal financial and health information, and prior to this act, had already established strict policies and procedures regarding this issue.
The Women’s Health and Cancer Rights Act (WHCRA) notice informs your employees of the federal regulation that requires all health plans that cover mastectomies to also cover reconstruction of the removed breast. |
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Download the Privacy/WHCRA Notice (N-53169) and make copies to share with your employees. |
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New Hospital Quality Web Tools
Use two new online hospital quality tools from The Blues® to help you and your employees become more knowledgeable health care consumers.
SELECT QUALITY CARE®
Look up and compare data for 161 procedures or diagnoses for hospitals throughout the United States. Data includes the number of patients treated at the hospital for that procedure or diagnosis, the complication rate, and the length of stay.
To access Select Quality Care, go to the Doctor and Hospital Finder on the Blue Cross and Blue Shield Association’s Web site www.bcbs.com. Enter the alpha prefix from your Wellmark ID card, and choose “Review Hospital Profile” to go to the Select Quality Care Web site.
Select Quality Care displays data for all hospitals regardless of their contracting status with their local Blue Plan. When using the site, employees are reminded to check contracting status prior to seeking services. Select Quality Care is powered by WebMD® Quality Services.
NETWORK HOSPITAL PERFORMANCE MEASUREMENT
(EMPLOYERS-ONLY)
Wellmark Blue Cross and Blue Shield is participating in a Network Hospital Performance Measurement program that gives group decision-makers access to a different set of hospital quality data. The tool provides data for contracting hospitals on three measures: heart attack (acute myocardial infarction), heart failure, and inpatient pneumonia.
After June 12, group benefits administrators who are registered users of Wellmark.com can access the Network Hospital Performance tool on the Employer section of www.wellmark.com. After logging in, choose “Health Care Quality” under the Resources link on the left navigation bar. |
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Go online to check out these new tools and let us know what you think. |
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