Update your assignment account data to avoid claim rejections

Coverage of hepatitis C
anti-viral drugs
How to report bilateral and
repeat procedures
Effective immediately, Harvoni and Sovaldi are the
Bilateral procedures are services that can be
preferred and covered anti-viral drugs for the
performed on organs or limbs on both sides of the
body, such as arms, knees and eyes. When reporting
treatment of hepatitis C. Viekira will not be covered
procedures performed bilaterally, the number of
unless one of our preferred drugs cannot be used.
services must correspond with the modifiers reported.
Medical necessity documentation for the use of Viekira
There are 2 ways to report bilateral procedures:
must be submitted for review and consideration.
We anticipate additional drugs will become available.
1. If reported on 2 lines of service, report an RT modifier
However, at present, these will not be covered unless
on one line and an LT modifier on the next line. The
number of services on each line will be one.
medical necessity documentation has been submitted,
reviewed and approved.
Example:
• 27447 LT $5,200.00 (01)
criteria for these medications, the presence of
2. If modifier 50 is reported to indicate bilateral
advanced fibrosis (Metavir F3) or compensated cirrhosis
procedures, report only one line of service and
(Metavir F4), as documented by either liver biopsy
paid
wilkes-barre, pa
permit no. 84
19 North Main Street
Wilkes-Barre, PA 18711-0302
bcnepa.com
Address Service Requested
Volume 17 • Issue 2 • February 2015
Editor:
Lily A. Stahley
Notify your patients
of Utilization
Management decisions
Blue Cross of Northeastern Pennsylvania administers health insurance
plans for Blue Cross of Northeastern Pennsylvania, Highmark Blue
Shield, First Priority Health® and First Priority Life Insurance Company®.
• 27447 RT $5,200.00 (01)
In addition to our already existing prior authorization
presorted
standard
u.s. postage
Blue Cross of Northeastern
Pennsylvania (BCNEPA) welcomes
Blue Cross of Northeastern Pennsylvania is a Qualified Health Plan
issuer in the Federally Facilitated Marketplace.
the opportunity to work closely
Independent Licensee of the Blue Cross and Blue Shield Association.
®Registered Mark of the Blue Cross and Blue Shield Association.
with you in providing quality
indicate number of services as 2.
or non-invasive markers of liver fibrosis (ultrasound,
Fibrosure, Fibrospect or other serum fibrosis marker),
care to your patients. Please
• 27447 50 $10,400.00 (2)
must be submitted along with the prior authorization
Repeat procedures are services performed on the
the Guidelines issued by the American Association for
same side of the body (for example, the right arm
the Study of Liver Diseases (AASLD) and the Infectious
and right leg).
Diseases Society of America (IDSA), establishing
There are 2 ways to report repeat procedures:
1. If services are performed on the same side of the
body, report the number of services as 2.
Also effective immediately, serum fibrosis marker
testing (FibroSure, FibroSpect and FibroScan) will be
Example:
• 20610 RT $140.00 (2)
covered under the member’s medical benefit. Our
complete policy regarding the coverage of hepatitis C
medications can be found under Utilization
modifier 76 on the second line to ensure correct
Management Criteria on the Rx Drug Benefits page
payment is made.
Example:
• 20610 RT $70.00 (01)
Please contact our Pharmacy Services department,
• 20610 RT 76 $70.00 (01)
at 1.800.722.4062, if you have any questions.
Thank you for your attention to this information
BCNEPA Provider
Relations Consultants
How you can reach us
For questions about benefits,
eligibility or claims
Please call, weekdays, between 8 a.m. and 5 p.m.
BlueCare® HMO/HMO Plus 1.800.822.8752
BlueCare PPO/myBlue® Plans 1.866.262.5635
BlueCare Traditional 1.888.827.7117
BlueCare EPO/Custom PPO 1.888.345.2353
Valuable health resources
2. If repeat procedures are billed on 2 lines, report
at bcnepa.com/pharmacy/umc.aspx.
Provider Bulletin for updates to
your Policy & Procedure Manual.
request. These recommendations are consistent with
When and In Whom to Initiate HCV Therapy.
remember to refer to the monthly
Provider Relations department
1.800.451.4447
Example:
Odette Ashby 570.200.4658
[email protected]
Important fax numbers
BC Claims 570.200.6790
(For claims adjustments, BlueCare Senior, FEP)
BC Precertification 570.200.6788
BlueCard® ITS Claims 570.200.6790
FPH Claims 570.200.6790
(For Maternity Precertification forms,
Claims Research Request forms,
adjustments, etc.)
Refer your BCNEPA patients to the
following health & wellness resources:
Blue Health SolutionsSM 1.866.262.4764
Call to speak with a health coach about
Provider Relations 570.200.6880
personalized health management and
wellness programs, care management
Provider Customer Service 570.200.6868
resources and much more.
FPH Complaint/Grievance 570.200.6770
24/7 Nurse Now 1.866.442.2583
Call anytime to speak to a registered nurse
FPH Non-par 570.200.6840
or chat online at bcnepa.com. Logon to Self-Service. Click on Health & Wellness Referral Requests
and select 24/7 Nurse Now.
FPH Pharmacy 570.200.6870
Report fraud
and for your service to our members.
(Policy Update 1702009)
(Policy Update 1702010)
Fraud Hotline 1.800.352.9100
To report fraud call our Fraud Hotline, or email our
Special Investigations Unit at [email protected].
FPH Precertification 570.200.6799
Cheryl Hashagen 570.200.4670
[email protected]
Jill Jenkins 570.200.4669
[email protected]
Louise LoPresto 570.200.4674
[email protected]
Tracie Wyandt 570.200.4647
[email protected]
Senior Manager,
Provider Relations
Dave Levenoskie 570.200.4673
[email protected]
Senior Manager,
Provider Services
Kevin Quaglia 570.200.4676
[email protected]
Questions?
Call Provider Relations at
1.800.451.4447
Other Party Liability (OPL) 570.200.6790
© Blue Cross of Northeastern Pennsylvania. 2015.
5
As a reminder, you or your staff
must notify patients of Utilization
Management decisions, both
approvals and denials, within
24 hours of the decision.
You must also document this
notification. This applies to all
Utilization Management decisions,
including medical, pharmacy and
behavioral health.
It’s our goal to work with you
to make better health easier for
your patients.
Update your assignment account data
to avoid claim rejections
Effective April 1, 2015, claims with incorrect provider information will be
rejected. If physicians and practitioners join or leave your assignment
account, be sure to add or delete them from your account profile right away.
Doing so will avoid rejections of claims that contain the name or ID number
of a practitioner who is no longer listed on your assignment account.
As of October 21, 2014, a performing provider must be associated with the
billing provider account or claims will reject as D5283: The combination of
Billing Provider and Performing/Rendering Provider is not valid. Please correct
and resubmit.
On January 12, 2015, we temporarily disabled the system fix, postponing
it until April 1, 2015, as a courtesy to our providers and allowing you a
60-day grace period in which to update your assignment accounts.
These rejected claims will be reprocessed. However, providers who do not
update their assignment accounts prior to March 31, 2015, will be at risk for
future rejections.
That’s why it is especially important that you verify, add and/or correct the
names and ID numbers for all practitioners who are part of an assignment
account. Accurate and up-to-date information will ensure that payments
of your claims are timely and correct, and services will not be billable to
the member.
The Provider Maintenance Request and Request for Addition-Deletion to
Existing Assignment Account forms are available at bcnepa.com/providers.
Click on Provider Resources and Tools, Reference Material and then
Provider Forms.
(Policy Update 1702002)
(Policy Update 1702001)
Table of Contents
2 Eye care professionals:
Screening for diabetic
retinal disease
4Medical Record
Documentation
2014 results
3 Prepare for ICD-10 with
“What’s Up Wednesday”
5 How to report bilateral
and repeat procedures
Eye care professionals:
Screening for diabetic
retinal disease
One of the quality measures monitored through the
Health Effectiveness Data Information Set (HEDIS) is the
Follow-Up: Care for severe and
persistent mental illness
Prepare for ICD-10 with
“What’s Up Wednesday”
New HEDIS Measures
available online
In the March 2014 issue of the Provider Bulletin, the
An ICD-10 preparedness teleconference series
from Pennsylvania’s Blues Plans:
Blue Cross of Northeastern Pennsylvania,
Capital BlueCross, Highmark Blue Shield and
Independence Blue Cross
The following HEDIS Measures will be added to
the HEDIS Homepage in February:
Quality Management department of Blue Cross of
Northeastern Pennsylvania announced an initiative to
identify members with a diagnosis of severe mental illness
completion of a retinal or dilated eye exam by an eye
(SMI) and to do qualitative analysis to identify gaps in care
care professional for all diabetics. Both the American
for this at risk population.
Diabetes Association and the American Academy of
Ophthalmology recommend annual eye exams for all
Required by updated NCQA (National Committee for Quality
Assurance) standards, Quality Management has looked at
data collected for the time frame of January 1, 2013, to
either an ophthalmologist or an optometrist.
December 31, 2013. Of those members with a diagnosis
documented in the patient’s record at his/her primary
that falls in the category of SMI, pharmacy claims were then
reviewed for prescriptions of atypical antipsychotics (second
generation) in this population. Based on recommendations
care provider’s office. In addition, the exam should be
outlined in the Clinical Practice Guideline for Psychosis
properly coded as a retinal or dilated eye exam.
and Schizophrenia in Adults: Treatment and Management,
You can use any of the following codes to document
that the patient has received a retinal or dilated eye
the following standards of care can be anticipated in concert
with the use of these medications:
• Fasting Blood Sugar or A1C Hg, because of the
exam or a negative retinal exam:
increased risk of Type II diabetes
CPT Codes:
2022F, 2024F, 2026F, 3072F, 67028, 67030, 67031,
67036, 67039, 67040, 67041, 67042, 67043, 67101,
67105, 67107, 67108, 67110, 67112, 67113, 67121,
67141, 67145, 67208, 67210, 67218, 67220, 67221,
67227, 67228, 92002, 92004, 92012, 92014, 92018,
92019, 92134, 92225, 92226, 92227, 92228, 92230,
92235, 92240, 92250, 92260
• Fasting Lipid Profile, because of the increased risk
of hyperlipidemia
• Follow-up Examination with a Primary Care Physician
or Prescribing Physician to monitor for side effects and
efficacy of the antipsychotic drugs
Preliminary data indicates that while the majority of the
When is the next call?
Wednesday, February 18, 2015, from 2:00 to 3:00 p.m.
Going forward, calls will take place on the third Wednesday
of each month.
How do I participate?
Before the call, visit the BCNEPA’s ICD-10 page at bcnepa.com.
On the Provider Homepage, select the Resources and Tools tab,
and then choose the Privacy/HIPAA/ICD-10 link. Click on
ICD-10 to access the presentation. Dial 1.800.882.3610 and
enter passcode 5411307 when prompted. Be sure to dial in
a few minutes early.
100%
100%
Medical Record Documentation.
Social history
98.48%
93.57% 
This evaluation was based on
Immunizations listed
97.83%
87.36% 
random selection.
Past medical history
100%
98.23% 
• Members, 18 to 59 years of age, whose BP was
<140/90 mm Hg
For the 2014 audit year, the
Follow-up
91.99%
91.93%
• Members, 60 to 85 years of age, with a diagnosis of
diabetes whose BP was <140/90 mm Hg
Credentialing Committee
PCP signs lab/imaging studies
99.54%
approved the monitoring of the
96.45% 
Consultant reports present
98.99%
96.92% 
Preventive services by age
95.68%
90.89% 
100%
99.33% 
few had the recommended lab studies to screen for type II
diabetes and hyperlipidemia. Because of these identified gaps
It’s important that your office sends a letter verifying
in care, letters will be sent out to the prescribing physicians to
the exam and the results to the patient’s primary care
recommend that these lab studies should be in their patients’
provider as soon as the exam is completed. This will
plan of care. This initiative will be an annual occurrence with
ensure that the patient is getting “Best Practice Care”
follow-up to measure the effectiveness of the targeted mailing.
along with capturing the essential data for
HEDIS reporting.
The Quality Improvement Committee is also researching the
adoption of the Clinical Practice Guideline referenced above
for use by our network providers.
remains at 84%.
Legible
The breakdown of the results
Advising smokers to quit
(focus study)
66.67%
54.72% 
Documentation of BMI, Pediatric/
Adult combined (focus study)
89.17%
85.87% 
Documentation of Pediatric/
Adolescent nutrition (focus study)
72.14%
82.68% 
Documentation of Pediatric/
Adolescent physical activity
(focus study)
72.22%
77.06% 
• Total number of offices
(Policy Update 1702006)
(Policy Update 1702005)
Reminder: NUCC 1500 claim form version 02/12
Over the past 2 years, we have issued many Provider Bulletin articles regarding the use of the new
National Uniform Claim Committee (NUCC) 02/12 claim form.
As a reminder, all First Priority Health, First Priority Life and Blue Cross of Northeastern Pennsylvania
paper claim submissions must be on the 02/12 version of the NUCC 1500 claim form.
Effective January 26, 2015, we will no longer accept claims submitted on the 08/05 form. All claims
received on the old 08/05 claim form will be returned to providers unprocessed.
To ensure your paper claims are processed, if you haven’t already done so, please begin using the
02/12 version of the 1500 claim form.
reviewed: 95
• Network standard score: 84%
• Percentage of offices
above standard: 96.8%
Using the 84% threshold, Table 1 illustrates the scored indicators. Indicators that showed a significant decrease from
2013 are Social history, which decreased by 4.91%; Immunizations listed, which decreased by 10.47%; Past medical
history, which decreased by 1.77%; PCP signs lab/imaging studies, which decreased by 3.09% and Preventive services
by age, which decreased by 4.79%.
Advising smokers to quit—which is not a scored indicator, but a focus study—has decreased in the past 2 years.
This indicator has been up and down over the last few years. Therefore, this focus study continues to offer an
opportunity for improvement. In 2013, in collaboration with Healthcare Effectiveness Data and Information Set
(HEDIS) data, we also added Documentation of BMI, Pediatric/Adult combined; Documentation of Pediatric/
Adolescent nutrition and Documentation of Pediatric/Adolescent physical activity as focus studies. These remain
stable and continue to show improvement.
The MRD chart audit is performed annually. We will continue to communicate the importance of documenting the
above listed indicators in the medical record and to provide feedback regarding compliance with these indicators.
Specific conversations and/or onsite coaching are performed during the audit if, and when, specific areas of
deficiencies are noted. Physicians who are found to be below standard in MRD will be mailed letters noting specific
areas of improvement, suggesting how to improve those areas and requesting a plan of action, if applicable.
If you would like copies of the MRD Practice Guidelines or chart forms, please visit the Provider Center at
bcnepa.com/providers or the Managed Care Center via Navinet.
(Policy Update 1702007)
(Policy Update 1702004)
2
The compliance threshold
The percentage of members, 18 years of age and
older during the measurement year, who were
hospitalized and discharged July 1 of the year prior to
the measurement year, who had a diagnosis of AMI and
received persistent beta-blocker treatment for
6 months after discharge.
If you need help completing the form, an instruction manual published by NUCC is available at nucc.org.
(Policy Update 1702003)
same indicators, as listed below.
for 2014 is as follows:
follow-up visits with a primary care physician or psychiatrist,
S0620, S0621, S0625, S3000
improvement, we evaluated
Measure Description:
members who were prescribed atypical antipsychotics had
HCPC Codes:
% Compliant 2013 % Compliant 2014
Medication/allergy list
Visit the HEDIS Homepage at bcnepa.com/
providers/qualitymanagement for these and other
measures with documentation tips, best practices, and
information about the importance of these measures to
your practice. Questions can be emailed before or during the teleconference
to [email protected].
Indicator
primary care offices in 2014 for
Persistence of Beta-Blocker Treatment
after a Heart Attack (PBH)
All providers, clearinghouses, trade associations and
information networks.
initiative for continuous quality
Table 1: Medical Record Documentation (MRD) Chart Audit
99.54% 
• Members, 60 to 85 years of age, without a diagnosis
of diabetes whose BP was <150/90 mm Hg
Who should participate?
Management department’s
100%
The percentage of members, 18 to 85 years of age,
who had a diagnosis of hypertension (HTN) and whose
blood pressure was adequately controlled during the
measurement year based on the following criteria:
Pennsylvania’s health care professionals about the transition to
ICD-10. “What’s Up Wednesday” will feature special guests and
ICD-10 experts who will lead discussions to help you get ready
for the October 1, 2015, compliance date.
As part of our Quality
Medical/surgical problem list
Measure Description:
“What’s Up Wednesday” is a monthly teleconference for
persons with diabetes. This test can be carried out by
It is vital that the completion of this exam be
Controlling High Blood Pressure (CBP)
Medical Record Documentation 2014 results
3
(Policy Update 1702008)
4
Eye care professionals:
Screening for diabetic
retinal disease
One of the quality measures monitored through the
Health Effectiveness Data Information Set (HEDIS) is the
Follow-Up: Care for severe and
persistent mental illness
Prepare for ICD-10 with
“What’s Up Wednesday”
New HEDIS Measures
available online
In the March 2014 issue of the Provider Bulletin, the
An ICD-10 preparedness teleconference series
from Pennsylvania’s Blues Plans:
Blue Cross of Northeastern Pennsylvania,
Capital BlueCross, Highmark Blue Shield and
Independence Blue Cross
The following HEDIS Measures will be added to
the HEDIS Homepage in February:
Quality Management department of Blue Cross of
Northeastern Pennsylvania announced an initiative to
identify members with a diagnosis of severe mental illness
completion of a retinal or dilated eye exam by an eye
(SMI) and to do qualitative analysis to identify gaps in care
care professional for all diabetics. Both the American
for this at risk population.
Diabetes Association and the American Academy of
Ophthalmology recommend annual eye exams for all
Required by updated NCQA (National Committee for Quality
Assurance) standards, Quality Management has looked at
data collected for the time frame of January 1, 2013, to
either an ophthalmologist or an optometrist.
December 31, 2013. Of those members with a diagnosis
documented in the patient’s record at his/her primary
that falls in the category of SMI, pharmacy claims were then
reviewed for prescriptions of atypical antipsychotics (second
generation) in this population. Based on recommendations
care provider’s office. In addition, the exam should be
outlined in the Clinical Practice Guideline for Psychosis
properly coded as a retinal or dilated eye exam.
and Schizophrenia in Adults: Treatment and Management,
You can use any of the following codes to document
that the patient has received a retinal or dilated eye
the following standards of care can be anticipated in concert
with the use of these medications:
• Fasting Blood Sugar or A1C Hg, because of the
exam or a negative retinal exam:
increased risk of Type II diabetes
CPT Codes:
2022F, 2024F, 2026F, 3072F, 67028, 67030, 67031,
67036, 67039, 67040, 67041, 67042, 67043, 67101,
67105, 67107, 67108, 67110, 67112, 67113, 67121,
67141, 67145, 67208, 67210, 67218, 67220, 67221,
67227, 67228, 92002, 92004, 92012, 92014, 92018,
92019, 92134, 92225, 92226, 92227, 92228, 92230,
92235, 92240, 92250, 92260
• Fasting Lipid Profile, because of the increased risk
of hyperlipidemia
• Follow-up Examination with a Primary Care Physician
or Prescribing Physician to monitor for side effects and
efficacy of the antipsychotic drugs
Preliminary data indicates that while the majority of the
When is the next call?
Wednesday, February 18, 2015, from 2:00 to 3:00 p.m.
Going forward, calls will take place on the third Wednesday
of each month.
How do I participate?
Before the call, visit the BCNEPA’s ICD-10 page at bcnepa.com.
On the Provider Homepage, select the Resources and Tools tab,
and then choose the Privacy/HIPAA/ICD-10 link. Click on
ICD-10 to access the presentation. Dial 1.800.882.3610 and
enter passcode 5411307 when prompted. Be sure to dial in
a few minutes early.
100%
100%
Medical Record Documentation.
Social history
98.48%
93.57% 
This evaluation was based on
Immunizations listed
97.83%
87.36% 
random selection.
Past medical history
100%
98.23% 
• Members, 18 to 59 years of age, whose BP was
<140/90 mm Hg
For the 2014 audit year, the
Follow-up
91.99%
91.93%
• Members, 60 to 85 years of age, with a diagnosis of
diabetes whose BP was <140/90 mm Hg
Credentialing Committee
PCP signs lab/imaging studies
99.54%
approved the monitoring of the
96.45% 
Consultant reports present
98.99%
96.92% 
Preventive services by age
95.68%
90.89% 
100%
99.33% 
few had the recommended lab studies to screen for type II
diabetes and hyperlipidemia. Because of these identified gaps
It’s important that your office sends a letter verifying
in care, letters will be sent out to the prescribing physicians to
the exam and the results to the patient’s primary care
recommend that these lab studies should be in their patients’
provider as soon as the exam is completed. This will
plan of care. This initiative will be an annual occurrence with
ensure that the patient is getting “Best Practice Care”
follow-up to measure the effectiveness of the targeted mailing.
along with capturing the essential data for
HEDIS reporting.
The Quality Improvement Committee is also researching the
adoption of the Clinical Practice Guideline referenced above
for use by our network providers.
remains at 84%.
Legible
The breakdown of the results
Advising smokers to quit
(focus study)
66.67%
54.72% 
Documentation of BMI, Pediatric/
Adult combined (focus study)
89.17%
85.87% 
Documentation of Pediatric/
Adolescent nutrition (focus study)
72.14%
82.68% 
Documentation of Pediatric/
Adolescent physical activity
(focus study)
72.22%
77.06% 
• Total number of offices
(Policy Update 1702006)
(Policy Update 1702005)
Reminder: NUCC 1500 claim form version 02/12
Over the past 2 years, we have issued many Provider Bulletin articles regarding the use of the new
National Uniform Claim Committee (NUCC) 02/12 claim form.
As a reminder, all First Priority Health, First Priority Life and Blue Cross of Northeastern Pennsylvania
paper claim submissions must be on the 02/12 version of the NUCC 1500 claim form.
Effective January 26, 2015, we will no longer accept claims submitted on the 08/05 form. All claims
received on the old 08/05 claim form will be returned to providers unprocessed.
To ensure your paper claims are processed, if you haven’t already done so, please begin using the
02/12 version of the 1500 claim form.
reviewed: 95
• Network standard score: 84%
• Percentage of offices
above standard: 96.8%
Using the 84% threshold, Table 1 illustrates the scored indicators. Indicators that showed a significant decrease from
2013 are Social history, which decreased by 4.91%; Immunizations listed, which decreased by 10.47%; Past medical
history, which decreased by 1.77%; PCP signs lab/imaging studies, which decreased by 3.09% and Preventive services
by age, which decreased by 4.79%.
Advising smokers to quit—which is not a scored indicator, but a focus study—has decreased in the past 2 years.
This indicator has been up and down over the last few years. Therefore, this focus study continues to offer an
opportunity for improvement. In 2013, in collaboration with Healthcare Effectiveness Data and Information Set
(HEDIS) data, we also added Documentation of BMI, Pediatric/Adult combined; Documentation of Pediatric/
Adolescent nutrition and Documentation of Pediatric/Adolescent physical activity as focus studies. These remain
stable and continue to show improvement.
The MRD chart audit is performed annually. We will continue to communicate the importance of documenting the
above listed indicators in the medical record and to provide feedback regarding compliance with these indicators.
Specific conversations and/or onsite coaching are performed during the audit if, and when, specific areas of
deficiencies are noted. Physicians who are found to be below standard in MRD will be mailed letters noting specific
areas of improvement, suggesting how to improve those areas and requesting a plan of action, if applicable.
If you would like copies of the MRD Practice Guidelines or chart forms, please visit the Provider Center at
bcnepa.com/providers or the Managed Care Center via Navinet.
(Policy Update 1702007)
(Policy Update 1702004)
2
The compliance threshold
The percentage of members, 18 years of age and
older during the measurement year, who were
hospitalized and discharged July 1 of the year prior to
the measurement year, who had a diagnosis of AMI and
received persistent beta-blocker treatment for
6 months after discharge.
If you need help completing the form, an instruction manual published by NUCC is available at nucc.org.
(Policy Update 1702003)
same indicators, as listed below.
for 2014 is as follows:
follow-up visits with a primary care physician or psychiatrist,
S0620, S0621, S0625, S3000
improvement, we evaluated
Measure Description:
members who were prescribed atypical antipsychotics had
HCPC Codes:
% Compliant 2013 % Compliant 2014
Medication/allergy list
Visit the HEDIS Homepage at bcnepa.com/
providers/qualitymanagement for these and other
measures with documentation tips, best practices and
information about the importance of these measures to
your practice. Questions can be emailed before or during the teleconference
to [email protected].
Indicator
primary care offices in 2014 for
Persistence of Beta-Blocker Treatment
after a Heart Attack (PBH)
All providers, clearinghouses, trade associations and
information networks.
initiative for continuous quality
Table 1: Medical Record Documentation (MRD) Chart Audit
99.54% 
• Members, 60 to 85 years of age, without a diagnosis
of diabetes whose BP was <150/90 mm Hg
Who should participate?
Management department’s
100%
The percentage of members, 18 to 85 years of age,
who had a diagnosis of hypertension (HTN) and whose
blood pressure was adequately controlled during the
measurement year based on the following criteria:
Pennsylvania’s health care professionals about the transition to
ICD-10. “What’s Up Wednesday” will feature special guests and
ICD-10 experts who will lead discussions to help you get ready
for the October 1, 2015, compliance date.
As part of our Quality
Medical/surgical problem list
Measure Description:
“What’s Up Wednesday” is a monthly teleconference for
persons with diabetes. This test can be carried out by
It is vital that the completion of this exam be
Controlling High Blood Pressure (CBP)
Medical Record Documentation 2014 results
3
(Policy Update 1702008)
4
Eye care professionals:
Screening for diabetic
retinal disease
One of the quality measures monitored through the
Health Effectiveness Data Information Set (HEDIS) is the
Follow-Up: Care for severe and
persistent mental illness
Prepare for ICD-10 with
“What’s Up Wednesday”
New HEDIS Measures
available online
In the March 2014 issue of the Provider Bulletin, the
An ICD-10 preparedness teleconference series
from Pennsylvania’s Blues Plans:
Blue Cross of Northeastern Pennsylvania,
Capital BlueCross, Highmark Blue Shield and
Independence Blue Cross
The following HEDIS Measures will be added to
the HEDIS Homepage in February:
Quality Management department of Blue Cross of
Northeastern Pennsylvania announced an initiative to
identify members with a diagnosis of severe mental illness
completion of a retinal or dilated eye exam by an eye
(SMI) and to do qualitative analysis to identify gaps in care
care professional for all diabetics. Both the American
for this at risk population.
Diabetes Association and the American Academy of
Ophthalmology recommend annual eye exams for all
Required by updated NCQA (National Committee for Quality
Assurance) standards, Quality Management has looked at
data collected for the time frame of January 1, 2013, to
either an ophthalmologist or an optometrist.
December 31, 2013. Of those members with a diagnosis
documented in the patient’s record at his/her primary
that falls in the category of SMI, pharmacy claims were then
reviewed for prescriptions of atypical antipsychotics (second
generation) in this population. Based on recommendations
care provider’s office. In addition, the exam should be
outlined in the Clinical Practice Guideline for Psychosis
properly coded as a retinal or dilated eye exam.
and Schizophrenia in Adults: Treatment and Management,
You can use any of the following codes to document
that the patient has received a retinal or dilated eye
the following standards of care can be anticipated in concert
with the use of these medications:
• Fasting Blood Sugar or A1C Hg, because of the
exam or a negative retinal exam:
increased risk of Type II diabetes
CPT Codes:
2022F, 2024F, 2026F, 3072F, 67028, 67030, 67031,
67036, 67039, 67040, 67041, 67042, 67043, 67101,
67105, 67107, 67108, 67110, 67112, 67113, 67121,
67141, 67145, 67208, 67210, 67218, 67220, 67221,
67227, 67228, 92002, 92004, 92012, 92014, 92018,
92019, 92134, 92225, 92226, 92227, 92228, 92230,
92235, 92240, 92250, 92260
• Fasting Lipid Profile, because of the increased risk
of hyperlipidemia
• Follow-up Examination with a Primary Care Physician
or Prescribing Physician to monitor for side effects and
efficacy of the antipsychotic drugs
Preliminary data indicates that while the majority of the
When is the next call?
Wednesday, February 18, 2015, from 2:00 to 3:00 p.m.
Going forward, calls will take place on the third Wednesday
of each month.
How do I participate?
Before the call, visit the BCNEPA’s ICD-10 page at bcnepa.com.
On the Provider Homepage, select the Resources and Tools tab,
and then choose the Privacy/HIPAA/ICD-10 link. Click on
ICD-10 to access the presentation. Dial 1.800.882.3610 and
enter passcode 5411307 when prompted. Be sure to dial in
a few minutes early.
100%
100%
Medical Record Documentation.
Social history
98.48%
93.57% 
This evaluation was based on
Immunizations listed
97.83%
87.36% 
random selection.
Past medical history
100%
98.23% 
• Members, 18 to 59 years of age, whose BP was
<140/90 mm Hg
For the 2014 audit year, the
Follow-up
91.99%
91.93%
• Members, 60 to 85 years of age, with a diagnosis of
diabetes whose BP was <140/90 mm Hg
Credentialing Committee
PCP signs lab/imaging studies
99.54%
approved the monitoring of the
96.45% 
Consultant reports present
98.99%
96.92% 
Preventive services by age
95.68%
90.89% 
100%
99.33% 
few had the recommended lab studies to screen for type II
diabetes and hyperlipidemia. Because of these identified gaps
It’s important that your office sends a letter verifying
in care, letters will be sent out to the prescribing physicians to
the exam and the results to the patient’s primary care
recommend that these lab studies should be in their patients’
provider as soon as the exam is completed. This will
plan of care. This initiative will be an annual occurrence with
ensure that the patient is getting “Best Practice Care”
follow-up to measure the effectiveness of the targeted mailing.
along with capturing the essential data for
HEDIS reporting.
The Quality Improvement Committee is also researching the
adoption of the Clinical Practice Guideline referenced above
for use by our network providers.
remains at 84%.
Legible
The breakdown of the results
Advising smokers to quit
(focus study)
66.67%
54.72% 
Documentation of BMI, Pediatric/
Adult combined (focus study)
89.17%
85.87% 
Documentation of Pediatric/
Adolescent nutrition (focus study)
72.14%
82.68% 
Documentation of Pediatric/
Adolescent physical activity
(focus study)
72.22%
77.06% 
• Total number of offices
(Policy Update 1702006)
(Policy Update 1702005)
Reminder: NUCC 1500 claim form version 02/12
Over the past 2 years, we have issued many Provider Bulletin articles regarding the use of the new
National Uniform Claim Committee (NUCC) 02/12 claim form.
As a reminder, all First Priority Health, First Priority Life and Blue Cross of Northeastern Pennsylvania
paper claim submissions must be on the 02/12 version of the NUCC 1500 claim form.
Effective January 26, 2015, we will no longer accept claims submitted on the 08/05 form. All claims
received on the old 08/05 claim form will be returned to providers unprocessed.
To ensure your paper claims are processed, if you haven’t already done so, please begin using the
02/12 version of the 1500 claim form.
reviewed: 95
• Network standard score: 84%
• Percentage of offices
above standard: 96.8%
Using the 84% threshold, Table 1 illustrates the scored indicators. Indicators that showed a significant decrease from
2013 are Social history, which decreased by 4.91%; Immunizations listed, which decreased by 10.47%; Past medical
history, which decreased by 1.77%; PCP signs lab/imaging studies, which decreased by 3.09% and Preventive services
by age, which decreased by 4.79%.
Advising smokers to quit—which is not a scored indicator, but a focus study—has decreased in the past 2 years.
This indicator has been up and down over the last few years. Therefore, this focus study continues to offer an
opportunity for improvement. In 2013, in collaboration with Healthcare Effectiveness Data and Information Set
(HEDIS) data, we also added Documentation of BMI, Pediatric/Adult combined; Documentation of Pediatric/
Adolescent nutrition and Documentation of Pediatric/Adolescent physical activity as focus studies. These remain
stable and continue to show improvement.
The MRD chart audit is performed annually. We will continue to communicate the importance of documenting the
above listed indicators in the medical record and to provide feedback regarding compliance with these indicators.
Specific conversations and/or onsite coaching are performed during the audit if, and when, specific areas of
deficiencies are noted. Physicians who are found to be below standard in MRD will be mailed letters noting specific
areas of improvement, suggesting how to improve those areas and requesting a plan of action, if applicable.
If you would like copies of the MRD Practice Guidelines or chart forms, please visit the Provider Center at
bcnepa.com/providers or the Managed Care Center via Navinet.
(Policy Update 1702007)
(Policy Update 1702004)
2
The compliance threshold
The percentage of members, 18 years of age and
older during the measurement year, who were
hospitalized and discharged July 1 of the year prior to
the measurement year, who had a diagnosis of AMI and
received persistent beta-blocker treatment for
6 months after discharge.
If you need help completing the form, an instruction manual published by NUCC is available at nucc.org.
(Policy Update 1702003)
same indicators, as listed below.
for 2014 is as follows:
follow-up visits with a primary care physician or psychiatrist,
S0620, S0621, S0625, S3000
improvement, we evaluated
Measure Description:
members who were prescribed atypical antipsychotics had
HCPC Codes:
% Compliant 2013 % Compliant 2014
Medication/allergy list
Visit the HEDIS Homepage at bcnepa.com/
providers/qualitymanagement for these and other
measures with documentation tips, best practices, and
information about the importance of these measures to
your practice. Questions can be emailed before or during the teleconference
to [email protected].
Indicator
primary care offices in 2014 for
Persistence of Beta-Blocker Treatment
after a Heart Attack (PBH)
All providers, clearinghouses, trade associations and
information networks.
initiative for continuous quality
Table 1: Medical Record Documentation (MRD) Chart Audit
99.54% 
• Members, 60 to 85 years of age, without a diagnosis
of diabetes whose BP was <150/90 mm Hg
Who should participate?
Management department’s
100%
The percentage of members, 18 to 85 years of age,
who had a diagnosis of hypertension (HTN) and whose
blood pressure was adequately controlled during the
measurement year based on the following criteria:
Pennsylvania’s health care professionals about the transition to
ICD-10. “What’s Up Wednesday” will feature special guests and
ICD-10 experts who will lead discussions to help you get ready
for the October 1, 2015, compliance date.
As part of our Quality
Medical/surgical problem list
Measure Description:
“What’s Up Wednesday” is a monthly teleconference for
persons with diabetes. This test can be carried out by
It is vital that the completion of this exam be
Controlling High Blood Pressure (CBP)
Medical Record Documentation 2014 results
3
(Policy Update 1702008)
4
Coverage of hepatitis C
anti-viral drugs
How to report bilateral and
repeat procedures
Effective immediately, Harvoni and Sovaldi are the
Bilateral procedures are services that can be
preferred and covered anti-viral drugs for the
performed on organs or limbs on both sides of the
treatment of hepatitis C. Viekira will not be covered
body, such as arms, knees and eyes. When reporting
procedures performed bilaterally, the number of
unless one of our preferred drugs cannot be used.
services must correspond with the modifiers reported.
Medical necessity documentation for the use of Viekira
There are 2 ways to report bilateral procedures:
must be submitted for review and consideration.
presorted
standard
u.s. postage
paid
wilkes-barre, pa
permit no. 84
19 North Main Street
Wilkes-Barre, PA 18711-0302
bcnepa.com
Address Service Requested
Volume 17 • Issue 2 • February 2015
1. If reported on 2 lines of service, report an RT modifier
We anticipate additional drugs will become available.
on one line and an LT modifier on the next line. The
However, at present, these will not be covered unless
number of services on each line will be one.
medical necessity documentation has been submitted,
reviewed and approved.
Example:
• 27447 LT $5,200.00 (1)
criteria for these medications, the presence of
2. If modifier 50 is reported to indicate bilateral
advanced fibrosis (Metavir F3) or compensated cirrhosis
procedures, report only one line of service and
(Metavir F4), as documented by either liver biopsy
Notify your patients
of Utilization
Management decisions
Blue Cross of Northeastern Pennsylvania administers health insurance
plans for Blue Cross of Northeastern Pennsylvania, Highmark Blue
Shield, First Priority Health® and First Priority Life Insurance Company®.
• 27447 RT $5,200.00 (1)
In addition to our already existing prior authorization
Editor:
Lily A. Stahley
Blue Cross of Northeastern
Pennsylvania (BCNEPA) welcomes
Blue Cross of Northeastern Pennsylvania is a Qualified Health Plan
issuer in the Federally Facilitated Marketplace.
the opportunity to work closely
Independent Licensee of the Blue Cross and Blue Shield Association.
®Registered Mark of the Blue Cross and Blue Shield Association.
with you in providing quality
indicate number of services as 2.
or non-invasive markers of liver fibrosis (FibroScan,
FibroSure, FibroSpect or other serum fibrosis marker),
care to your patients. Please
• 27447 50 $10,400.00 (2)
must be submitted along with the prior authorization
Repeat procedures are services performed on the
the Guidelines issued by the American Association for
same side of the body (for example, the right arm
the Study of Liver Diseases (AASLD) and the Infectious
and right leg).
There are 2 ways to report repeat procedures:
When and In Whom to Initiate HCV Therapy.
1. If services are performed on the same side of the
body, report the number of services as 2.
Also effective immediately, serum fibrosis marker
testing (FibroSure, FibroSpect and FibroScan) will be
covered under the member’s medical benefit. Our
Example:
• 20610 RT $140.00 (2)
complete policy regarding the coverage of hepatitis C
modifier 76 on the second line to ensure correct
Management Criteria on the Rx Drug Benefits page
payment is made.
at bcnepa.com/pharmacy/umc.aspx.
Example:
Please contact our Pharmacy Services department,
• 20610 RT $70.00 (1)
at 1.800.722.4062, if you have any questions.
• 20610 RT 76 $70.00 (1)
Thank you for your attention to this information
and for your service to our members.
BCNEPA Provider
Relations Consultants
How you can reach us
For questions about benefits,
eligibility or claims
Please call, weekdays, between 8 a.m. and 5 p.m.
BlueCare® HMO/HMO Plus 1.800.822.8752
BlueCare PPO/myBlue® Plans 1.866.262.5635
BlueCare Traditional 1.888.827.7117
BlueCare EPO/Custom PPO 1.888.345.2353
Valuable health resources
2. If repeat procedures are billed on 2 lines, report
medications can be found under Utilization
Provider Bulletin for updates to
your Policy & Procedure Manual.
request. These recommendations are consistent with
Diseases Society of America (IDSA), establishing
remember to refer to the monthly
Provider Relations department
1.800.451.4447
Example:
Odette Ashby 570.200.4658
[email protected]
Important fax numbers
BC Claims 570.200.6790
(For claims adjustments, BlueCare Senior, FEP)
BC Precertification 570.200.6788
BlueCard® ITS Claims 570.200.6790
FPH Claims 570.200.6790
(For Maternity Precertification forms,
Claims Research Request forms,
adjustments, etc.)
Refer your BCNEPA patients to the
following health & wellness resources:
Blue Health SolutionsSM 1.866.262.4764
Call to speak with a health coach about
Provider Relations 570.200.6880
personalized health management and
wellness programs, care management
Provider Customer Service 570.200.6868
resources and much more.
FPH Complaint/Grievance 570.200.6770
24/7 Nurse Now 1.866.442.2583
Call anytime to speak to a registered nurse
FPH Non-par 570.200.6840
or chat online at bcnepa.com. Logon to Self-Service. Click on Health & Wellness Referral Requests
and select 24/7 Nurse Now.
FPH Pharmacy 570.200.6870
Report fraud
(Policy Update 1702009)
(Policy Update 1702010)
Fraud Hotline 1.800.352.9100
To report fraud call our Fraud Hotline, or email our
Special Investigations Unit at [email protected].
FPH Precertification 570.200.6799
Cheryl Hashagen 570.200.4670
[email protected]
Jill Jenkins 570.200.4669
[email protected]
Louise LoPresto 570.200.4674
[email protected]
Tracie Wyandt 570.200.4647
[email protected]
Senior Manager,
Provider Relations
Dave Levenoskie 570.200.4673
[email protected]
Senior Manager,
Provider Services
Kevin Quaglia 570.200.4676
[email protected]
Questions?
Call Provider Relations at
1.800.451.4447
Other Party Liability (OPL) 570.200.6790
© Blue Cross of Northeastern Pennsylvania. 2015.
5
As a reminder, you or your staff
must notify patients of Utilization
Management decisions, both
approvals and denials, within
24 hours of the decision.
You must also document this
notification. This applies to all
Utilization Management decisions,
including medical, pharmacy and
behavioral health.
It’s our goal to work with you
to make better health easier for
your patients.
Update your assignment account data
to avoid claim rejections
Effective April 1, 2015, claims with incorrect provider information will be
rejected. If physicians and practitioners join or leave your assignment
account, be sure to add or delete them from your account profile right away.
Doing so will avoid rejections of claims that contain the name or ID number
of a practitioner who is no longer listed on your assignment account.
As of October 21, 2014, a performing provider must be associated with the
billing provider account or claims will reject as D5283: The combination of
Billing Provider and Performing/Rendering Provider is not valid. Please correct
and resubmit.
On January 12, 2015, we temporarily disabled the system fix, postponing
it until April 1, 2015, as a courtesy to our providers and allowing you a
60-day grace period in which to update your assignment accounts.
These rejected claims will be reprocessed. However, providers who do not
update their assignment accounts prior to March 31, 2015, will be at risk for
future rejections.
That’s why it is especially important that you verify, add and/or correct the
names and ID numbers for all practitioners who are part of an assignment
account. Accurate and up-to-date information will ensure that payments
of your claims are timely and correct, and services will not be billable to
the member.
The Provider Maintenance Request and Request for Addition-Deletion to
Existing Assignment Account forms are available at bcnepa.com/providers.
Click on Provider Resources and Tools, Reference Material and then
Provider Forms.
(Policy Update 1702002)
(Policy Update 1702001)
Table of Contents
2 Eye care professionals:
Screening for diabetic
retinal disease
4Medical Record
Documentation
2014 results
3 Prepare for ICD-10 with
“What’s Up Wednesday”
5 How to report bilateral
and repeat procedures
Coverage of hepatitis C
anti-viral drugs
How to report bilateral and
repeat procedures
Effective immediately, Harvoni and Sovaldi are the
Bilateral procedures are services that can be
preferred and covered anti-viral drugs for the
performed on organs or limbs on both sides of the
body, such as arms, knees and eyes. When reporting
treatment of hepatitis C. Viekira will not be covered
procedures performed bilaterally, the number of
unless one of our preferred drugs cannot be used.
services must correspond with the modifiers reported.
Medical necessity documentation for the use of Viekira
There are 2 ways to report bilateral procedures:
must be submitted for review and consideration.
We anticipate additional drugs will become available.
1. If reported on 2 lines of service, report an RT modifier
However, at present, these will not be covered unless
on one line and an LT modifier on the next line. The
number of services on each line will be one.
medical necessity documentation has been submitted,
reviewed and approved.
Example:
• 27447 LT $5,200.00 (01)
criteria for these medications, the presence of
2. If modifier 50 is reported to indicate bilateral
advanced fibrosis (Metavir F3) or compensated cirrhosis
procedures, report only one line of service and
(Metavir F4), as documented by either liver biopsy
paid
wilkes-barre, pa
permit no. 84
19 North Main Street
Wilkes-Barre, PA 18711-0302
bcnepa.com
Address Service Requested
Volume 17 • Issue 2 • February 2015
Editor:
Lily A. Stahley
Notify your patients
of Utilization
Management decisions
Blue Cross of Northeastern Pennsylvania administers health insurance
plans for Blue Cross of Northeastern Pennsylvania, Highmark Blue
Shield, First Priority Health® and First Priority Life Insurance Company®.
• 27447 RT $5,200.00 (01)
In addition to our already existing prior authorization
presorted
standard
u.s. postage
Blue Cross of Northeastern
Pennsylvania (BCNEPA) welcomes
Blue Cross of Northeastern Pennsylvania is a Qualified Health Plan
issuer in the Federally Facilitated Marketplace.
the opportunity to work closely
Independent Licensee of the Blue Cross and Blue Shield Association.
®Registered Mark of the Blue Cross and Blue Shield Association.
with you in providing quality
indicate number of services as 2.
or non-invasive markers of liver fibrosis (ultrasound,
Fibrosure, Fibrospect or other serum fibrosis marker),
care to your patients. Please
• 27447 50 $10,400.00 (2)
must be submitted along with the prior authorization
Repeat procedures are services performed on the
the Guidelines issued by the American Association for
same side of the body (for example, the right arm
the Study of Liver Diseases (AASLD) and the Infectious
and right leg).
Diseases Society of America (IDSA), establishing
There are 2 ways to report repeat procedures:
1. If services are performed on the same side of the
body, report the number of services as 2.
Also effective immediately, serum fibrosis marker
testing (FibroSure, FibroSpect and FibroScan) will be
Example:
• 20610 RT $140.00 (2)
covered under the member’s medical benefit. Our
complete policy regarding the coverage of hepatitis C
medications can be found under Utilization
modifier 76 on the second line to ensure correct
Management Criteria on the Rx Drug Benefits page
payment is made.
Example:
• 20610 RT $70.00 (01)
Please contact our Pharmacy Services department,
• 20610 RT 76 $70.00 (01)
at 1.800.722.4062, if you have any questions.
Thank you for your attention to this information
BCNEPA Provider
Relations Consultants
How you can reach us
For questions about benefits,
eligibility or claims
Please call, weekdays, between 8 a.m. and 5 p.m.
BlueCare® HMO/HMO Plus 1.800.822.8752
BlueCare PPO/myBlue® Plans 1.866.262.5635
BlueCare Traditional 1.888.827.7117
BlueCare EPO/Custom PPO 1.888.345.2353
Valuable health resources
2. If repeat procedures are billed on 2 lines, report
at bcnepa.com/pharmacy/umc.aspx.
Provider Bulletin for updates to
your Policy & Procedure Manual.
request. These recommendations are consistent with
When and In Whom to Initiate HCV Therapy.
remember to refer to the monthly
Provider Relations department
1.800.451.4447
Example:
Odette Ashby 570.200.4658
[email protected]
Important fax numbers
BC Claims 570.200.6790
(For claims adjustments, BlueCare Senior, FEP)
BC Precertification 570.200.6788
BlueCard® ITS Claims 570.200.6790
FPH Claims 570.200.6790
(For Maternity Precertification forms,
Claims Research Request forms,
adjustments, etc.)
Refer your BCNEPA patients to the
following health & wellness resources:
Blue Health SolutionsSM 1.866.262.4764
Call to speak with a health coach about
Provider Relations 570.200.6880
personalized health management and
wellness programs, care management
Provider Customer Service 570.200.6868
resources and much more.
FPH Complaint/Grievance 570.200.6770
24/7 Nurse Now 1.866.442.2583
Call anytime to speak to a registered nurse
FPH Non-par 570.200.6840
or chat online at bcnepa.com. Logon to Self-Service. Click on Health & Wellness Referral Requests
and select 24/7 Nurse Now.
FPH Pharmacy 570.200.6870
Report fraud
and for your service to our members.
(Policy Update 1702009)
(Policy Update 1702010)
Fraud Hotline 1.800.352.9100
To report fraud call our Fraud Hotline, or email our
Special Investigations Unit at [email protected].
FPH Precertification 570.200.6799
Cheryl Hashagen 570.200.4670
[email protected]
Jill Jenkins 570.200.4669
[email protected]
Louise LoPresto 570.200.4674
[email protected]
Tracie Wyandt 570.200.4647
[email protected]
Senior Manager,
Provider Relations
Dave Levenoskie 570.200.4673
[email protected]
Senior Manager,
Provider Services
Kevin Quaglia 570.200.4676
[email protected]
Questions?
Call Provider Relations at
1.800.451.4447
Other Party Liability (OPL) 570.200.6790
© Blue Cross of Northeastern Pennsylvania. 2015.
5
As a reminder, you or your staff
must notify patients of Utilization
Management decisions, both
approvals and denials, within
24 hours of the decision.
You must also document this
notification. This applies to all
Utilization Management decisions,
including medical, pharmacy and
behavioral health.
It’s our goal to work with you
to make better health easier for
your patients.
Update your assignment account data
to avoid claim rejections
Effective April 1, 2015, claims with incorrect provider information will be
rejected. If physicians and practitioners join or leave your assignment
account, be sure to add or delete them from your account profile right away.
Doing so will avoid rejections of claims that contain the name or ID number
of a practitioner who is no longer listed on your assignment account.
As of October 21, 2014, a performing provider must be associated with the
billing provider account or claims will reject as D5283: The combination of
Billing Provider and Performing/Rendering Provider is not valid. Please correct
and resubmit.
On January 12, 2015, we temporarily disabled the system fix, postponing
it until April 1, 2015, as a courtesy to our providers and allowing you a
60-day grace period in which to update your assignment accounts.
These rejected claims will be reprocessed. However, providers who do not
update their assignment accounts prior to March 31, 2015, will be at risk for
future rejections.
That’s why it is especially important that you verify, add and/or correct the
names and ID numbers for all practitioners who are part of an assignment
account. Accurate and up-to-date information will ensure that payments
of your claims are timely and correct, and services will not be billable to
the member.
The Provider Maintenance Request and Request for Addition-Deletion to
Existing Assignment Account forms are available at bcnepa.com/providers.
Click on Provider Resources and Tools, Reference Material and then
Provider Forms.
(Policy Update 1702002)
(Policy Update 1702001)
Table of Contents
2 Eye care professionals:
Screening for diabetic
retinal disease
4Medical Record
Documentation
2014 results
3 Prepare for ICD-10 with
“What’s Up Wednesday”
5 How to report bilateral
and repeat procedures