Recognizing Physician Excellence SM Program

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Recognizing

Physician Excellence

SM

Program

Guide to Physician Tools and Resources

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Recognizing Physician Excellence (RPE) Program

Guide to Physician Tools and Resources

Introduction

Welcome to the Recognizing Physician Excellence program Guide to

Physician Tools and Resources. This guide directs you to information about the

Blueprint for Health programs that are available to you, our valued physicians, and our members.

Blueprint for Health®is Blue Cross and Blue Shield of Florida’s (BCBSF’s) whole-person approach to integrated care and service. It includes programs and

service solutions for:

• Prevention and wellness • Decision support tools

• Chronic and acute condition support • Health care provider support

On the following pages, you will find both physician and member program summaries and links to websites that provide comprehensive program information.

As a member of BCBSF’s RPE program, you play an important role in serving our members. We appreciate your commitment to quality care and excellent service and thank you for participating in the RPE program.

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Physician Programs

1. Secure Connectivity (eMedicine)

eMedicine offers an alternative to an office visit. For members who prefer using the Internet to access health care information, e-Medicine is perfect. It saves time and can reduce work absenteeism. Using e-Medicine, a new prescription can be filled, lab results can be shared, and an appointment with a doctor or a referral can be made. e-Medicine is a safe and confidential way to communicate about non-urgent health care needs. It's as easy to use as email and incorporates security measures that ensure patient privacy.

For more information click on the link below:

http://www.bcbsfl.com/index.cfm?fuseaction=phyHIT.home

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2. ePrescribing

ePrescribing provides the capability to write and transmit prescriptions

electronically. A physicianmay also view drug formularies and comprehensive drug reference information as well as patient medication history.

For more information click here.

http://www.bcbsfl.com/index.cfm?fuseaction=phyHIT.home

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3. Availity®1 CareProfile

The Availity Care Profile is a secure, electronic record that provides a history of a patient’s health care services—no matter which doctor, hospital or other provider (such as a lab or pharmacy) rendered the service that was submitted to BCBSF for payment or which health plan the patient was covered under at the time. With this consolidated record, physicians have a more thorough picture of a patient’s medical history. This supports improved delivery of care to the patient, more informed health care decisions and a better health care experience for the patient.

For more information:

1. Log on to Availity, www.availity.com 2. Click on Products and Services 3. Click on Health Records

1 Availity, L.L.C., is a multi-payer, joint venture company. For more information, or to register, please visit Availity's

website at www.availity.com.

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4. CareCalc®

CareCalc enables physician office staff to calculate the patient’s financial responsibility at any time during the service, starting with scheduling the appointment through the completion of an office visit.

For more information click on the link below:

http://www.bcbsfl.com/DocumentLibrary/Providers/FAQs_CareCalc2.pdf

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5. Availity Health Information Network

Using a secure online gateway, the AvailityHealth Information Network optimizes the flow of information between physicians, health plans, pharmacies and other health care providers.

Through the Availity Health Information Network providers can: • Check eligibility and benefits

• Submit claims • Check claims status

• Request a Health Care Service Review (precertification, authorizations and referrals)

• Receive an Electronic Remittance Advice

Availity offers a HIPAA-AS compliant, fast and efficient way to exchange

information and conduct health care transactions that reduce health care costs, simplify provider workflows, and improve the patient experience.

1. Log on to Availity, www.availity.com 2. Click on Products and Services 3. Click on Demonstration

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6. Health Dialog®

In 2002, BCBSF contracted with Health Dialog, a resource for health information, to help members incorporate their personal values and preferences into their health care choices. Health Dialog provides a whole person approach to chronic condition management and decision support to assist our members with better managing their health decisions and effectively communicating with their doctors regarding treatment options.

Health Dialog can help you educate your patients and provides a source for answers to their questions about chronic diseases such as asthma, CAD, CHF, COPD, diabetes, hypertension and others.

As one of our valued RPE program physicians, you have the opportunity to refer our chronically ill members directly to Health Dialog for the six chronic diseases described above.

http://www.bcbsfl.com/index.cfm?fuseaction=HealthInformationServices.home

Click here for the Health Dialog Referral Form

As a courtesy, BCBSF has entered into arrangements with various vendors to provide value-added features that include care decision support tools and

services to its members. These programs are not part of insurance coverage. All decisions should be made in conjunction with the physician, since neither BCBSF nor its vendors provide medical care or advice.

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7. Disease Management

The Disease Management program offers proactive personalized support services for health care management. The program is designed to

help members cope with pain, prevent complications and deal with the emotional challenges of a long-term, complex condition. Targeted outreach, decision

support, health coaching, education and customized care plans help enhance the quality and experience of care our members receive.

http://www.bcbsfl.com/index.cfm?fuseaction=phyMemberEducation.home

For the Case Management Referral Form:

http://www.bcbsfl.com/DocumentLibrary/Providers/CaseMgmtReferralForm.pdf

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8. Diagnostic Imaging Guidelines

BCBSF contracts with National Imaging Associates, Inc., (NIA) to provide imaging guidelines via their website link included below. Treatment decisions remain solely the decision of qualified medical personnel. The guidelines are provided for informational purposes only.

For more information on authorizations click on the link below:

http://www.bcbsfl.com/DocumentLibrary/Providers/ImagingEquipGuidelines.pdf

Click here for fast tracker:

http://www.bcbsfl.com/DocumentLibrary/Providers/FT_NIA.pdf

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9. Prevention Screening Criteria

The RPE program measures the care and quality of both preventive screenings and care of chronic conditions. This is your direct link to the latest clinical

recommendations made by the U.S. Preventive Services Task Force (USPSTF). Blue Cross and Blue Shield of Florida, Inc. and Health Options, Inc. have

adopted the USPSTF’s Guide to Clinical Preventive Services for adults and children.

Preventive Services

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10. Decision Support Tools

The Healthcare AdvisorSM

can assist physicians and members research medical conditions or procedures, review physician education, training, affiliations and certifications, conduct side-by-side comparison on area hospitals based on quality and risk-adjusted data, and view estimates for the cost of specific health care services. The tools are also available in Spanish.

1. Log into www.Availity.com using the Registered User’s Login 2. Click on Payer Resources at the top of the page

3. Under Payer Resources select BCBSF 4. Under Tools select Researching a Physician 5. Select:

• Healthcare Advisor • Physician Advisor • Hospital Advisor

• Treatment Cost Advisor

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11. CAHPS® Satisfaction Survey Questions

The Consumer Assessment of Health Plan Survey (CAHPS) measures member satisfaction with services provided by their doctors and health plans. The annual survey covers aspects such as the ability to get needed care, the ability to get care quickly and how well doctors communicate.

https://www.cahps.ahrq.gov/cahpskit/CG/CGChooseQX.asp

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Fax to: (800) 308-4015

Health Dialog Referral Form

If you would like a Health Dialog coach to call a member to encourage them to follow your treatment plan and provide them with disease management information, complete this form and fax it to (800) 308-4015.

Patient Information

Patient Last Name Patient First Name

Member ID Number (alpha prefix and numbers) Patient Date of Birth Gender

Male Female

Street Address City State Zip

Telephone Number

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Reason for Referral: ____________________________________________________________

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Physician Name: ___________________________________ Provider Number: __________________________________ 900-784-0409 15 Reset [Table of Contents]