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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 ARCHIVED ON WWW.WELLMARK.COM.
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Wellmark Health Plan of Iowa: Coverage Changes for Flu Vaccine and Medical Equipment
Wellmark Health Plan of Iowa is making two benefit changes to coverage applicable to both self-funded and fully insured Blue Advantage,® Blue Access,® and Blue Choice® health plans. Both changes take effect October 1, 2007:
- Flu vaccine available from specialists: Members can receive flu vaccine (shot/mist) from a specialist. Previously, flu vaccine benefits were available only when
administered by a primary care physician (PCP).
- Home/durable medical equipment: Health care providers are no longer required to notify Wellmark Health Plan of Iowa of a referral to receive benefits for home/durable medical equipment, prosthetic appliances, and orthotics. The $250 threshold
requirement for these medical devices also has been removed.
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Removing these coverage limitations increases access to care, and means less hassle for members and providers. Please contact your Wellmark representative or authorized agent for questions. |
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Chiropractic Care Planning
Wellmark Blue Cross and Blue Shield is enhancing its chiropractic care planning process for our Alliance SelectSM product to provide a clearer picture of your employees’ chiropractic treatment when they start receiving chiropractic services. Beginning September 30, 2007, when your employees see a Wellmark Blue Cross and Blue Shield participating chiropractor, the chiropractor will submit a Chiropractic Care Plan to Wellmark outlining the anticipated course of treatment for their condition or symptom. The care planning process does not change member benefits. Medical necessity has always been, and continues to be, a contract requirement.
Here’s how the program works:
- After the first visit, the chiropractor submits a Care Plan to Wellmark via Web, fax, or mail; most Care Plans should take less than a few minutes to complete
- After submitting the Care Plan, the chiropractor will receive written notice within two business days verifying whether or not the anticipated services meet Wellmark’s medical necessity guidelines, a coverage requirement
- Members will receive a letter only when the Care Plan is not approved as submitted
- For members currently receiving chiropractic services, starting September 30, the chiropractor will need to submit a Care Plan
- Only one Care Plan needs to be submitted for the member’s entire course of treatment; if additional services are needed after the initial Care Plan is completed, an Extension of Care request will need to be submitted to report additional diagnoses and update the treatment plan request
The Chiropractic Care Planning program is designed to provide better data to help quantify the value of chiropractic services for Wellmark customers and the chiropractic profession.
At this time, the new care planning process is not applicable to Wellmark Health Plan of Iowa products, which include Blue Advantage, Blue Access, and Blue Choice because these products have different requirements or benefits from standard Wellmark member policies and benefit certificates. |
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Pharmacy Prior Authorization Changes
Reminder: Three pharmacy prior authorization programs take effect September 15, 2007:
Sedative Hypnotics
- Members must try and fail generic Ambien (zolpidem tartrate) before coverage is available for Ambien CR, Sonata, Lunestra, and Rozerem.
- Approval from Wellmark is required if a physician wants the member to continue using their current sedative hypnotic drug, and there is no previous claims history for brand or generic Ambien.
Non-Sedative Antihistamines
- Prior authorization is required for Xyzal, a non-sedating antihistamine. Xyzal is similar to both Allegra (also available as a generic) and Zyrtec.
- Members are required to try and fail generic Allegra and Zyrtec before coverage is available for Xyzal. This PA goes into effect as soon as Xyzal is available at the pharmacy (Xyzal is a new drug that just received FDA approval; since there is no utilization before the PA went into place, there is no need for member communications — just provider notice about the PA requirement)
Antifungals
- Wellmark will no longer provide coverage for Penlac, Sporanox, Lamisil, and their generic equivalents when prescribed for cosmetic
purposes.
- Prior authorization requests need to be submitted to Wellmark for approval for antifungals being prescribed for medical purposes.
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Members currently taking these drugs and physicians who have patients affected by the prior authorization requirements received letters in mid-August alerting them about the changes. For more information about these prior authorization changes, refer to the August edition of News From Blue. |
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New Automated Process for Updating Member Addresses
Wellmark is now updating employee addresses monthly, based upon
information we receive from the U.S. Postal Service National Change of Address (NCOA) database. Wellmark’s entire membership address file system
is automatically “cleansed” monthly. Previously, this process was completed manually only once during the course of a year. The new process decreases the time delay and costs of misrouted mail.
Wellmark’s membership department is collaborating with employer groups
that submit electronic eligibility files to keep member records synchronized. Initially, the automated process may result in an unexpected increase in address changes. Subsequent updates should produce fewer changes, as eligibility files are updated.
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Your support of this enhancement to our eligibility system is appreciated. Please contact your Wellmark account management team or membership representative with questions. |
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Blue PrioritySM Flex: IRS Proposed Cafeteria Plan Regulations Released
Long-anticipated IRS regulations on cafeteria plans have finally been released, replacing prior guidance issued at various times over the past 20 years. The proposed regulations provide mostly favorable changes to the rules governing cafeteria plans, health and dependent care flexible spending accounts (FSAs), and other benefits. The proposed regulations are not scheduled to go into effect until January 1, 2009. Wellmark is currently reviewing the proposed regulations and will inform you of any significant changes that need to be communicated to your employees regarding your cafeteria plan. Be assured we will update your plan documents as required and will assist in communicating these changes accordingly.
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New Deadline for Blue Priority Flex Members
Blue Priority Flex members will have a new deadline for January 2008 renewal. New or renewing member enrollment forms are now due December 1, 2007. New or renewing groups thereafter would need to send in their enrollment forms one month or four weeks prior to their effective/ renewal date. If enrollment forms are not received by the requested date, the processing of contributions, claims, and disbursements cannot be guaranteed to begin on the first day of the plan year. The flex renewal has been updated to include the deadline for submitting member enrollment forms. As a result, you may want to hold your annual enrollment meetings earlier than before to accommodate the deadline.
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Questions regarding the updated Flex deadline for member enrollment forms can be directed to the Flex Department at
1-800-624-2755 or flexadmin@wellmark.com. |
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New Disease Management Phone Number for Fully-Insured Members
Fully-insured members who participate in the Wellmark Blue Cross and Blue Shield’s Disease Management program have a new phone number to call for help managing their chronic health conditions — 1-866-816-5264.
Wellmark’s Disease Management services provide help to plan members with chronic conditions to coordinate their health care, understand and follow their physician’s treatment plans, and maintain healthy behaviors.
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Disease Management is a standard feature of fully-insured group plans, and a buy-up option for self-funded employers. Learn more about Wellmark’s health management programs by selecting Products and Services in the Employer section of www.wellmark.com. |
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Physical Activity Recommendations
Recently, the American Heart Association and the American College of Sports Medicine announced new recommendations for the amount of physical activity most adults should be getting every day. Check out the official report.
What’s New About Exercise?
Here’s what you need to know about the new physical activity recommendations:
- Five days or three days — take your pick. Adults should be getting at least 30 minutes of moderately intense activity for five days a week, or 20 minutes of vigorously intense activity at least three days of the week.
- You can still break up your activity into smaller amounts. But remember, it has to be at least for 10 minutes. So walk for 10 minutes, shovel for 12, and ride your bike for 10 and you’ve reached the goal!
- You don’t have to stop at 30 minutes! Doing more than the minimum is going to provide even more health benefits and is always encouraged
- There is a difference between aerobic exercise and resistance training. Even though mixing in some muscle strengthening exercises as part of your routine is part of this new recommendation, this doesn’t count as your daily physical activity.
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