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REVIEWFOR CONTRACTING INSTITUTIONAL AND PROFESSIONAL PROVIDERS DECEMBER 2012 WHAT’S INSIDE? Introducing Reference Based Pricing Enhancements to ClaimsXtenTM Code Auditing Tool ...... 2 Employers continue to seek alternative approaches to help take more control of Submitting Preventive Colonoscopy health care expenses, some of which include placing a greater emphasis on employee Claims with Modifi er 33 ...... 2 accountability in making health care decisions. Employers have been offered a new benefi t − Reference Based Pricing – which limits certain benefi ts for specifi ed Process Reminders for procedures to a specifi c dollar amount. With Reference Based Pricing, the benefi t Self-administered Drugs ...... 3 maximum – called the reference cost – is predetermined for a selection of individual Physical Medicine Utilization Management non-emergency outpatient procedures. Program Updates ...... 4 You may begin to see Blue Cross and Blue Shield of Illinois (BCBSIL) members and Ancillary Provider Claim Filing Guideline out-of-area Blue Cross and Blue Shield (BCBS) members who belong to employer Reminders with Modifi er 33 ...... 4 groups with Reference Based Pricing as early as Jan. 1, 2013. Diagnostic Testing Incentive Program To determine if Reference Based Pricing applies to your patient, you should check for City of Chicago Members ...... 5 eligibility and benefi ts as you normally would – via an electronic transaction through Credentialing Reminder: your preferred vendor, or by utilizing the BCBSIL interactive voice response system. For Don’t lose your PPO network privileges! ...... 5 out-of-area members, you may contact the BlueCard® Eligibility Line at 800-676-2583. BlueWorldwide Expat® Product Terminated, There is nothing you will need to do differently when fi ling claims. Effective Nov. 30, 2012 ...... 6 Watch for further information in the Blue Review.

Verifi cation of eligibility and/or benefi t information is not a guarantee of payment. Benefi ts will be Get to know ICD-10. determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certifi cate of coverage It changes everything. applicable on the date services were rendered. Industry experts recommend targeting Oct. 1, 2013, (one full year before the proposed Oct. 1, 2014, compliance date) as the ICD-10 readiness date to begin testing the new code set with trading partners. Sign up for one of our December webinars to help you plan for a successful ICD-10 conversion. December’s webinars will include information about: • Code structure • Code translation • Implementation phases • Testing and simulation, including illustrative results and claim examples For ICD-10 Webinar dates and times, refer to the Provider Learning Opportunities on page 3. We also encourage you to complete our ICD-10 Provider Readiness Assessment Survey, which is available in the Standards and Requirements/ ICD-10 section of our website at bcbsil.com/provider.

VISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER FairnessFairness in in ContractingContracting Submitting Preventive Colonoscopy Claims with Modifi er 33 In an effort to comply with fairness in contracting legislation and keep our The Affordable Care Act (ACA) Preventive Services provision requires coverage of preventive independently contracted providers services such as colorectal cancer screening without member cost-sharing when the member is informed, BCBSIL has designated a covered by a non-grandfathered group health plan. For BCBSIL members, this means the preventive column in the Blue Review to notify service must be covered with no coinsurance, deductible or copay when the patient covered under a you of any signifi cant changes to the non-grandfathered group health plan uses independently contracted providers in the BCBSIL physician fee schedules. Be sure to review network. this area each month.

Annual Procedure Code Update: WHAT IS A GRANDFATHERED HEALTH PLAN? Health plans with at least one individual enrolled on March 23, 2010, are considered to be On Jan. 1, 2013, BCBSIL will implement grandfathered, unless certain changes have been made since that date to cause a loss of CPT and HCPCS procedure code grandfathered status. At this time, grandfathered health plans are not required to implement additions, deletions and revisions. some of the new ACA requirements, including the requirement to cover preventive services Please note that codes that will be with no cost-sharing. Those plans that do not meet the requirements for grandfathered status deleted will not be accepted for payment are considered non-grandfathered. for service dates on or after Jan. 1, 2013.

The information above is not intended As part of our commitment to implement the Preventive Care Services provision in ACA, BCBSIL to be an exhaustive listing of all the has automated processing for preventive colonoscopy claims with modifi ers PT and 33. Health care changes. Annual and quarterly fee providers should already be using the new Current Procedural Terminology (CPT®) modifi er 33, schedule updates can also be requested which became effective Jan. 1, 2011. Modifi er 33 may be used when the primary purpose of the by using the Fee Schedule Request service is the delivery of an evidence-based service in accordance with a legislative or regulatory Form. Specifi c code changes that are preventive services mandate. listed above can also be obtained by downloading the Fee Schedule Request Here are some helpful tips on using modifi ers for preventive services: Form and specifi cally requesting the • If the purpose of the procedure is to screen for colorectal cancer and the service becomes updates on the codes listed in the diagnostic during the procedure, both modifi er PT and 33 may be used. Blue Review. The form is available in the Education and Reference Center/Forms • Modifi er 33 can be used alone when the service remains preventive throughout the procedure. section of our Provider website at • Modifi er 33 is not used for non-preventive colonoscopies or other non-preventive procedures. bcbsil.com/provider. • At least one of the preventive modifi ers must be used in order for the colonoscopy claim to pay as preventive. • A colonoscopy procedure will pay at the no cost-sharing benefi t level as long as modifi er 33 is Enhancements to used alone or in combination with the PT modifi er (PT+33). TM ClaimsXten Code • Colonoscopies not billed with one of the preventive modifi ers will not be paid as a preventive Auditing Tool screening. If a procedure is billed as a preventive screening, BCBSIL will assume that colonoscopy benefi ts BCBSIL will implement an expanded should be applied based on the intent of the test and not on the fi ndings. If a problem is found version of the ClaimsXten code during the screening and a procedure is performed to address the problem (such as polyp removal), the claim will still be paid as preventive with no member cost sharing – as long as it has been billed auditing tool, with the new 2013 using the appropriate preventive modifi ers. If the procedure is not billed as preventive, it will not be CPT/HCPCS codes and additional paid as a preventive screening. bundling logic, into our claim processing system beginning on or Please note that BCBSIL will review a previously processed colonoscopy screening claim if requested after Feb. 25, 2013. by a patient or provider.

For updates on the ClaimsXten For answers to frequently asked questions (FAQs), refer to the Preventive Colonoscopy Claim FAQs implementation and other BCBSIL in the Standards and Requirements/Coding Related Updates section of our Provider website at news, programs and initiatives, refer bcbsil.com/provider. to the BCBSIL Provider website at bcbsil.com/provider. Additional CPT copyright 2010 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. information also may be included in upcoming issues of the Blue Review. For more information about the United States Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer, refer to http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm. ClaimsXten is a trademark of McKesson This material is for informational purposes only and is not the provision of legal advice. If you have any Information Solutions, Inc., an independent questions regarding the law, you should consult with your legal advisor. third party vendor that is solely responsible for its products and services. Verifi cation of eligibility and/or benefi t information is not a guarantee of payment. Benefi ts will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certifi cate of coverage applicable on the date services were rendered.

21 VISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER Process Reminders for Provider Learning Opportunities Self-administered Drugs For those medications that are approved by the U.S. Food and Drug Administration (FDA) for self- administration, BCBSIL members are required to use their pharmacy benefi t and acquire the medication through a pharmacy benefi t provider. For your patients to receive benefi t coverage, the covered self-administered drugs must not be dispensed through the physician’s offi ce or a Home Infusion Therapy (HIT) Ancillary provider (where the HIT Ancillary provider is shipping drugs to a member’s home for self-administration). As a reminder, effective Jan. 1, 2013, BCBSIL WEBINARS AND WORKSHOPS BCBSIL will implement a system edit Below is a list of complimentary training sessions sponsored by BCBSIL. For details and that will deny services submitted on professional electronic (ANSI 837P) online registration, visit the Workshops/Webinars page in the Education and Reference Center and paper (CMS-1500) claims for drugs of our website at bcbsil.com/provider. that are FDA-approved for self- administration and that are covered under the member’s prescription drug WEBINARS benefi t. Denied service lines on the claim will receive the following message: Dec. 5, 2012 “Self-administered drugs submitted by a medical professional provider are not Dec. 12, 2012 Electronic Refund Management All sessions: within the member’s medical benefi ts. These charges must be billed and (eRM) 2 to 3 p.m. Dec. 19, 2012 submitted by a pharmacy provider.” To help you determine the correct path Dec. 26, 2012 for medication fulfi llment and ensure that the correct benefi t is applied, a Dec. 11, 2012 10 to 11:30 a.m. Specialty Pharmacy Program Drug List is available in the Pharmacy Program/ Specialty Pharmacy section of our ICD-10 Dec. 12, 2012 11 a.m. to 12:30 p.m. This month’s webinars will introduce you to website at bcbsil.com/provider. This list the process for building your project team Dec. 13, 2012 1 to 2:30 p.m. will identify those drugs that are and the project phases leading to successful approved for self-administration and therefore covered under the patient’s implementation of ICD-10. Dec. 18, 2012 1 to 2:30 p.m. pharmacy benefi t. Dec. 19, 2012 10 to 11:30 a.m. Please continue to watch the Blue Review, as well as the News and Updates section iEXCHANGE® Webinars of our Provider website for additional iEXCHANGE is a web-based application that To view available topics, To request training, announcements on BCBSIL programs, can be used to submit transaction requests visit the Workshops/ contact us at announcements and initiatives. for inpatient admissions and extensions, Webinars page in the [email protected] Pharmacy benefi ts and limits are subject treatment searches, provider/member Education and Reference and include your name, to the terms set forth in the member’s searches and select outpatient services Center on our website at telephone number and the certifi cate of coverage which may vary from and extensions. Customized training bcbsil.com/provider. topics of interest. the limits set forth above. The listing of any is available upon request. particular drug or classifi cation of drugs is not a guarantee of benefi ts. Members should refer to their certifi cate of coverage for more AVAILITY® WEBINARS details, including benefi ts, limitations and Availity also offers free webinars for their registered users. For a current listing of webinar exclusions. topics, dates and times, registered Availity users may log on to the secure Availity provider Prime Therapeutics Specialty Pharmacy portal—the Live Webinar Schedule is located under the Free Training tab. Not yet registered LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime with Availity? Visit their website at availity.com for details; or call Availity Client Services at Therapeutics LLC, a pharmacy benefi t 800-AVAILITY (282-4548) for assistance. management company. BCBSIL contracts with Prime Therapeutics to provide Availity is a registered trademark of Availity, LLC, an independent third party vendor. pharmacy benefi t management, prescription home delivery and specialty BCBSIL makes no endorsement, representations or warranties regarding any products or services offered pharmacy services. BCBSIL, as well as by Availity. The vendor is solely responsible for the products or services offered by them. If you have any several other independent Blue Cross and questions regarding the services offered here, you should contact the vendor directly. Blue Shield Plans, has an ownership interest in Prime Therapeutics.

DECEMBER 2012 3 Physical Medicine Ancillary Provider Claim Filing Guideline Utilization Management Reminders with Modifi er 33 Program Updates Attention: Durable/Home Medical Equipment (DME) Suppliers, Independent Clinical Laboratories and Specialty Pharmacies In our October 2012, Blue Review, we announced a new physical medicine This article is being included as a reminder regarding ancillary provider claim fi ling guidelines, utilization management (UM) which were updated in March 2012. Articles on this topic were published previously in the program for PPO professional Blue Review in late 2011, and early 2012. Information also was posted on our Provider website. providers for the following outpatient We realize that your company may provide services to Blue Cross and Blue Shield (BCBS) physical medicine services: members across the United States, with local provider agreements with BCBS Plans in many states. Generally, health care providers should fi le claims for their BCBS patients to the local Blue Plan. • Chiropractic Services However, there are unique circumstances when claim fi ling directions will differ, based on the • Occupational Therapy (OT) type of provider and service. • Physical Therapy (PT) The ancillary provider claim fi ling guidelines were updated effective March 1, 2012, to help standardize claim fi ling procedures, regardless of your location or any contracting arrangements We anticipate the program start date you may have with a BCBS Plan in another state. See below for a summary of where to fi le and to be in the spring of 2013. For what to include in addition to other information, as required, on your professional electronic additional information, Physical (ANSI 837P) or paper (CMS-1500) claims. Medicine UM Program FAQs will be DME PROVIDERS posted on Dec. 17, 2012, under Related You must bill the BCBS Plan in whose service area the equipment was shipped to the member, Resources on the Prior Authorization rented or purchased at a retail store. page in the Claims and Eligibility Location on section of our Provider website at Field/Loop Name Location on 837P CMS-1500 bcbsil.com/provider. Patient’s Address (Identifi es the member’s permanent address, which may Additional information will be Loop 2010CA Field 5 published in upcoming issues of the be used to determine the Local Plan, absent any additional information that might be submitted with the claim) Blue Review, as well as in the News and Updates section of our Provider Ordering Provider Loop 2420E (line level) Fields 17, 17b website. Place of Service Loop 2300, CLM05-1 Field 24B Please note that the fact that a guideline is Service Facility Location Information Loop 2310C available for any given treatment, or that a (Enter the location where the equipment was shipped to, Field 32 (claim level) service has been preauthorized, is not a rented or purchased) guarantee of payment. Benefi ts will be determined once a claim is received and INDEPENDENT CLINICAL LABORATORIES will be based upon, among other things, the member’s eligibility and the terms of You must bill the BCBS Plan in whose service area the specimen is collected. the member’s certifi cate of coverage Location on applicable on the date services were Field/Loop Name Location on 837P CMS-1500 rendered. Name of Referring Provider or Other Source Loop 2310A (When lab claims are submitted for the analysis only, Fields 17, 17b (claim level) the specimen draw location must be populated here) Service Facility Location Information (Enter the location where the services were rendered/ Loop 2310C where the specimen was collected. Note: Field 32 is 32 (claim level) required if fi eld 20 is checked “yes” for Charges for lab services performed outside of the physician’s offi ce)

SPECIALTY PHARMACIES You must bill the BCBS Plan in the service area where the ordering physician is located. Location on Field/Loop Name Location on 837P CMS-1500

Name of Referring Provider or Other Source Loop 2310A (Enter the referring, ordering or supervising provider’s Fields 17, 17b (claim level) fi rst name, middle initial, last name and credentials)

Loop 2310C Service Facility Location Information 32 (Enter the location where the services were rendered) (claim level)

Exception: The updated guidelines do not apply to claims submitted for Federal Employee Program (FEP) members. You should continue to submit claims for FEP members according to your current procedure.

4 VISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER Diagnostic Testing Incentive Program for Credentialing Reminder: Don’t lose your PPO City of Chicago Members network privileges!

PPO provider credentialing is currently in progress. PPO providers who may need to be credentialed at this time include independently contracted physicians (M.D., D.O.), physician assistants, advanced practice nurses, chiropractors, podiatrists, audiologists, optometrists, all behavioral health providers and certifi ed nurse midwives. If you are new to the credentialing process, you will receive a welcome packet from the Council for Affordable Quality Healthcare, Inc. (CAQH®) The City of Chicago will implement a diagnostic testing incentive program beginning containing Universal Provider Jan. 1, 2013. As a part of this program, the following will be paid at 100 percent, with Datasource® (UPD®) registration no deductible, coinsurance or copay: instructions and a personal CAQH Provider ID number. • All independent labs (such as Quest Diagnostics) Please note that the credentialing process • CAT, MRI and PET scans performed at a free-standing imaging center can take time to complete. Therefore, if you receive a letter, it is important to Members must use a free-standing in-network lab, such as Quest, for diagnostic tests respond without delay. If you have any ordered by their physician in order for covered expenses to be paid in full. If a member questions or need assistance with using uses a hospital-based laboratory, or if their claims for lab services are billed by a hospital the CAQH database, contact the CAQH or other facility, the expenses are subject to deductible and coinsurance. If CAT, MRI and Help Desk at 888-599-1771, or send an PET scans are billed by the hospital, the expenses are subject to deductible and email to [email protected]. coinsurance. For additional details, visit the Network Participation/Credentialing To identify City of Chicago members, look for the CTY alpha prefi x on the member’s ID section of our Provider website at card. Applicable group numbers are P17600, P16628, P16642, P16643, P16602 and P16632. bcbsil.com/provider. Always refer to the back of the member’s ID card to verify prior authorization requirements The Council for Affordable Quality and appropriate contact information. Healthcare, Inc. (CAQH) is a not-for-profi t collaborative alliance of the nation’s As a reminder, the City of Chicago requires that all of its members, including non- leading health plans and networks. The Medicare Retirees, submit a request for determination of medical necessity through mission of CAQH is to improve health care Telligen for approval of CAT, MRI and PET scans. All CAT, MRI and PET scans must be access and quality for patients and reduce administrative requirements for physicians certifi ed by Telligen to be medically necessary. Claims submitted for the services listed and other health care providers and their above without prior authorization through Telligen may be denied.* offi ce staffs. CAQH is solely responsible for its products and services, including the *Note: The City of Chicago is an exception. For most other BCBSIL members with PPO Universal Provider Datasource. or BlueChoice Select coverage, obtaining a Radiology Quality Initiative (RQI) number through AIM Specialty HealthSM (AIM®) is required by BCBSIL prior to ordering outpatient, non-emergency high-tech imaging studies. For more information on AIM and the RQI process for high-tech imaging services, please visit the Claims and Eligibility/ Prior Authorization section of our website at bcbsil.com/provider.

Telligen and AIM are independent third party vendors that are solely responsible for the products and services they offer. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions about the products or services they offer, you should contact the vendor(s) directly.

The fact that a guideline is available for any given treatment, or that a service has been preauthorized, is not a guarantee of payment. Benefi ts will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certifi cate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the back of the member’s ID card.

DECEMBERJULY 2012 2012 5

BlueWorldwide Expat® new account groups Product Terminated, Group Alpha Effective Group Name Product Type Effective Nov. 30, 2012 Number PrefixP Date ACEC Life Health Effective Nov. 30, 2012, BCBS health Trust Select Health P39934 ASC PPO (Portable) Jan. 1, 2013 insurance coverage for members with Plan BlueWorldwide Expat was terminated. These members carry ID cards with Arrow Gear Company P40315 XOF BlueEdge PPO/HSA (Portable) Jan. 1, 2013 alpha prefix EXF. 555770 CEH PPO (Portable) 555771 CEX PPO (Portable) As part of the Blue Cross and Blue CEC Employee 555772 CEZ PPO (Portable) Jan. 1, 2013 Group Shield Association’s Blue International 555773 CEY PPO (Portable) Strategy, the BlueWorldwide Expat 555774 CEC PPO (Portable) product will be replaced by Worldwide Centene 846321 TYN PPO (Portable) Jan. 1, 2013 Insurance Services (doing business as Corporation 846322 NER PPO (Portable) GeoBlueSM, the International Solutions P40883 XOF BlueScript PPO Licensee). As a result, effective Dec. 1, Connor Winfield Dec. 1, 2012 B40881 XOH BlueAdvantage HMO 2012, the Blue System will provide three separate offerings for international Continental Casualty 685439 SRY BlueEdge PPO/HSA (Portable) Jan. 1, 2013 travelers and expatriates: Company

• BlueCard Worldwide® – Part of Dolton School P46446 XOF PPO (Portable) Nov. 1, 2012 domestic coverage for local and District #149 National Account business. 900031, 900033, CEP BlueEdge PPO/HSA (Portable) 900035-6, • FEP Overseas – Coverage extended 900040, to government employees overseas. 900043 090010, 090012 CEP PPO (Portable) • GeoBlue – A Blue-branded Licensee 090016, 090052-3, Exelon Corporation Jan. 1, 2013 administering the International 090056-7, P90068-9, Solutions Licensee (ISL) products. 900030, 900032, 900034, 900037 As a reminder, always check eligibility 900039, 900042 090022-3 CEP CMM (Portable) and benefits prior to rendering services 900038, 900041 XOT CMM (Portable) by using your preferred electronic vendor portal, or by calling First Midwest 555758 FMB BlueEdge PPO/HSA (Portable) Jan. 1, 2013 800-676-BLUE (800-676-2583). Bancorp, Inc.

Please note the following: Flying Food Group 778343-4, 778346-7 FFQ PPO/FSA (Portable) Dec. 1, 2012 • You should not accept ID cards with alpha prefix EXF after Forsythe Technology P93910 FYT BlueEdge PPO/HCA (Portable) Jan. 1, 2013 Nov. 30, 2012. Claims for services rendered after this date will not be The Havi Group P40184 XOF BlueEdge PPO/HSA (Portable) Jan. 1, 2013 reimbursed.

866725, 866726, MRZ BlueEdge PPO/HCA (Portable) • For services rendered on or before Horace Mann 866727, 866728 Jan. 1, 2013 Nov. 30, 2012, submit all claims to Service Corporation 866729 MRZ PPO (Portable) BCBSIL by April 1, 2013. P40339, P40341, • Original claims and adjustments Indian Prairie School P40349, P40351, XOF BlueEdge PPO/HSA (Portable) Jan. 1, 2013 submitted after April 1, 2013, District 204 P40361 for services provided on or before Nov. 30, 2012, will not be reimbursed. Kemper Corporation 771231-41 UTN BlueEdge PPO/HSA (Portable) Jan. 1, 2013

Lutheran Social P40210, P40217 XOF BlueEdge PPO/HSA (Portable) Services of Illinois Jan. 1, 2013 P40235 XOF BlueEdge PPO/HCA (Portable) (LSSI)

6 Visit our Website at bcbsil.com/pr OVIDER NEW ACCOUNT GROUPS (continued) Medical Policy Updates

Group Alpha Effective Approved, new or revised BCBSIL Group Name Product Type Number Prefi xP Date Medical Policies and their effective dates are usually posted on our website the P39472 XOF PPO (Portable) fi rst day of each month. Medical Menasha Corporation Jan. 1, 2013 P39495 XOF BlueEdge PPO/HSA (Portable) policies, both new and revised, are used as guidelines for benefi t determinations Midwest Palliative in health care benefi t programs for most P40388 XOF BlueEdge PPO/HSA (Portable) Jan. 1, 2013 Hospice Care Center BCBSIL members, unless otherwise indicated. These policies may impact Moline School P14608 XOF PPO (Portable) Jan. 1, 2013 your reimbursement and your patients’ District 40 benefi ts. Small Newspaper P49629 XOF PPO (Portable) Dec. 1, 2012 Although medical policies can be used Group, Inc. as a guide, HMO providers should refer Tenneco, Inc. P40888, P40892 TVH BlueEdge PPO/HCA (Portable) Jan. 1, 2013 to the HMO Scope of Benefi ts in the BCBSIL Provider Manual, which P40366, P40369 XOF PPO (Portable) is located in the Standards and Village of Orland Park P40376 Jan. 1, 2013 Requirements section of our website H00004 XOH HMO (Portable) at bcbsil.com/provider.

Wintrust Financial You may view active, new and revised 053622, 053625 WTE PPO (Portable) Jan. 1, 2013 Corporation policies, along with policies pending implementation, by visiting the NOTE: Some of the accounts listed above may be new additions to BCBSIL; some accounts may already be Standards and Requirements/Medical established, but may be adding member groups or products. The information noted above is current as of Policy section of our website at the date of publication; however, BCBSIL reserves the right to amend this information at any time without bcbsil.com/provider. Select “View all notice. The fact that a group is included on this list is not a guarantee of payment or that any individuals Active and Pending Medical Policies.” employed by any of the listed groups, or their dependents, will be eligible for benefi ts. Benefi t coverage is After confi rming your agreement with subject to the terms and conditions set forth in the member’s certifi cate of coverage. the Medical Policies disclaimer, you will be directed to the Medical Policies Home page. IN THE Be Smart. Be Well.® You may also view draft medical policies ✓ that are under development, or are in KNOW Raises Concussion Awareness the process of being revised, by selecting “View and comment on Draft Medical Policies.” After confi rming your According to the Centers for Disease Control and Prevention (CDC), U.S. emergency departments agreement with the Medical Policies treat nearly 175,000 traumatic brain injuries (TBIs) in children and teenagers annually.* Many of disclaimer, you will be directed to the these injuries are related to sports and recreational activities. Draft Medical Policies page. Just click on Our BeSmartBeWell.com website now highlights Sports and Concussions with information and the title of the draft policy you wish to videos featuring young people with TBIs who share stories of their accidents and their recovery. review, and then select “Comments” to The videos also offer information and advice from clinical experts in the fi eld of TBIs, including: submit your feedback to us. • Defi nition of concussions Please visit the Standards and • Signs and symptoms of concussions Requirements/Medical Policy section • Importance of concussion and injury education and prevention of our website at bcbsil.com/provider • Post-concussion care and treatments for access to the most complete and up-to-date medical policy information. We encourage you to review the latest concussion information and videos at besmartbewell.com. Be Smart. Be Well. is a free website available to BCBSIL members and to the general public. Its goal The BCBSIL Medical Policies are for is simple: To help consumers stay healthier and safer through increased awareness and easy-to-use informational purposes only and are not a information. Encourage your patients to visit the website regularly for information on TBIs, and replacement for the independent medical judgment of physicians. Physicians are other topics such as teen driving, domestic violence, childhood asthma, managing pregnancy risks, instructed to exercise their own clinical food safety, drug safety and others. judgment based on each individual patient’s health care needs. Some benefi t plans *http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6039a1.htm administered by BCBSIL, such as some These programs are for informational purposes only, and self-funded employer plans or governmental are not a substitute for the sound medical judgment of a doctor. plans, may not utilize BCBSIL Medical Members are encouraged to talk to their doctor if they have any Policy. Members should contact their local questions or concerns regarding their health. customer services representative for specifi c coverage information.

DECEMBERMARCH 2012 2012 7 PRSRT STD U.S. POSTAGE PAID PERMIT NO. 581 CHICAGO, IL

REVIEWFOR CONTRACTING INSTITUTIONAL AND PROFESSIONAL PROVIDERS

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