1. No category

update
SM
April 2015
ICD-10: External testing
update and tips for a
successful conversion
page 5
EDI web resources
updated
page 6
User guides and
webinar now available
for recent NaviNet®
transaction changes
page 16
Inside this edition
Business Transformation
►►Business Transformation has been completed
ICD-10
►►Join us for the next What’s Up Wednesday call on
April 15, 2015
►►External testing update and tips for a successful conversion
Billing
►►EDI web resources updated
►►Updated process for submitting an overpayment/refund
request
●● Correction: Claim submission requirements when billing with
place of service code 22
Medical
►►NaviNet to provide direct access link to CareCore’s provider
Partners in Health UpdateSM is a publication
of Independence Blue Cross and its affiliates
(Independence), created to provide valuable
information to the Independence-participating provider
community. This publication may include notice of
changes or clarifications to administrative policies and
procedures that are related to the covered services
you provide in accordance with your participating
professional provider, hospital, or ancillary
provider/ancillary facility contract with Independence.
This publication is the primary method for
communicating such general changes.
Suggestions are welcome.
Contact information:
Provider Communications
Independence Blue Cross
1901 Market Street
27th Floor
Philadelphia, PA 19103
[email protected]
portal
►►Medical and claim payment policy activity posted from
February 21 – March 23, 2015
Quality Management
●● Highlighting HEDIS : Well-child visits in the first 15 months
of life
®
►►Independence’s Medicare utilization remains within national
standards
►►Improving lead testing among CHIP members
NaviNet®
►►User guides and webinar now available for recent NaviNet
transaction changes
Health and Wellness
►►Know your terms
►►Free mobile health tool for your patients: CareCam app now
available for diabetes and asthma self-management
Models are used for illustrative purposes only. Some illustrations
in this publication copyright 2015 www.dreamstime.com. All rights
reserved.
Independence Blue Cross offers products through its subsidiaries
Independence Hospital Indemnity Plan, Keystone Health Plan
East and QCC Insurance Company, and with Highmark Blue
Shield — independent licensees of the Blue Cross and Blue Shield
Association.
This is not a statement of benefits. Benefits may vary based on state
requirements, Benefits Program (HMO, PPO, etc.), and/or employer
groups. Providers should call Provider Services for the member’s
applicable benefits information. Members should be instructed to call
the Customer Service telephone number on their ID card.
The third-party websites mentioned in this publication are maintained
by organizations over which Independence exercises no control,
and accordingly, Independence disclaims any responsibility for the
content, the accuracy of the information, and/or quality of products
or services provided by or advertised in these third-party sites. URLs
are presented for informational purposes only. Certain services/
treatments referred to in third-party sites may not be covered by all
benefits plans. Members should refer to their benefits contract for
complete details of the terms, limitations, and exclusions of their
coverage.
NaviNet is a registered trademark of NaviNet, Inc., an independent
company.
FutureScripts and FutureScripts Secure are independent companies
that provide pharmacy benefits management services.
CPT copyright 2014 American Medical Association. All rights
reserved. CPT is a registered trademark of the American Medical
Association.
For articles specific to your area of interest, look for the appropriate icon:
Professional
Facility
Ancillary
►►Articles designated with a blue arrow include notice of
changes or clarifications to administrative policies and
procedures.
Keystone Health Plan East, Personal Choice®, Keystone 65
HMO, and Personal Choice 65SM PPO have an accreditation
status of Commendable from NCQA.
BUSINESS TRANSFORMATION
Business Transformation has been completed
Independence is pleased to announce that the transition
of our membership and claims processing to a new
operating platform has been completed. As you know,
Independence began this transition in November 2013.
The new platform offers greater capabilities, increased
flexibility in benefit design, and enhanced functionalities
to improve the overall customer experience.
This important transition included the following
milestones:
●● Transition of X12 transactions. All trading partners
send and receive transactions to/from the Highmark
Gateway as of November 1, 2013.
●● FEP claims. Institutional claims processing for Federal
Employee Program (FEP) members was migrated to
the new platform on November 1, 2013. Professional
claims processing for FEP members should continue
to be submitted with Highmark as the payer.
●● Host claims. Claims processing for professional Host
Medicare Advantage PPO (MA PPO) BlueCard®
claims and institutional Host claims was migrated to
the new platform on November 1, 2013.
●● Medicare Advantage HMO and PPO member
claims. All Medicare Advantage HMO and PPO
members were migrated to the new platform on
January 1, 2015.
●● Commercial member claims. All commercial
members have now been migrated to the new
platform. This transition of commercial member claims
happened over time, generally based on when the
customer/member’s contract renewed.
Important changes as a result of the
transition
Check member ID cards at every visit
Because all members were issued a new member ID
card upon migration, it is imperative that provider offices
do the following:
1.Obtain a copy of the member’s current ID card at
every visit to ensure that you submit the most
up-to-date information to Independence.
2.Verify eligibility and benefits using NaviNet prior to
rendering service.
Below are some of the important changes that occurred
as a result of our transition to the new platform.
These changes affect the way you do business with
Independence.
●● Member ID cards/numbers. As members were
migrated to the new platform, they were issued a new
member ID card with a new ID number and, in some
cases, a new alpha prefix. The subscriber and all
members covered under the subscriber’s policy share
the same ID number.
●● Provider payment. Now that all members are
migrated, you will receive a different format of the
Statement of Remittance (SOR) – called the Provider
Explanation of Benefits (professional) and Provider
Remittance (facility). On the new format for facility
claims, services have been combined and displayed
April 2015 | Partners in Health UpdateSM
on one line. Note: You will continue to receive an
SOR for dates of service that occurred prior to the
member’s migration to the new platform. In addition,
835 transactions generated on the new platform
contain additional and updated information. Please
refer to our Trading Partner Business Center at
www.highmark.com/edi-ibc for more specific
information.
●● Claims processing. Additional data elements are
required to ensure proper claims processing on
the new platform. For example, taxonomy codes
are required on all claims submissions. Information
regarding the specific data elements required can
be found in the Independence Blue Cross HIPAA
Transaction Standard Companion Guide, which is
available at www.ibx.com/edi.
●● Provider Automated System. Now that all members
have been migrated to the new platform, the
Provider Automated System is no longer available
for any functionality (e.g., eligibility, claims status,
authorizations). Providers must use the NaviNet® web
portal to retrieve this information.
●● NaviNet. Many changes have been implemented
on Independence NaviNet Plan Central,
including adding, removing, and enhancing
transactions. For more specific information,
please refer to the NaviNet Transaction Changes
section of our Business Transformation site at
www.ibx.com/pnc/businesstransformation. This section
of our site contains user guides and webinars for the
new or enhanced transactions.
For more information
For more information related to our Business
Transformation, go to www.ibx.com/pnc/
businesstransformation. This site contains a
communication archive as well as a frequently
asked questions (FAQ) document. If you still have
questions after reviewing the FAQ, email us at
[email protected]. 
3
www.ibx.com/providers
ICD-10
Join us for the next What’s Up Wednesday call
on April 15, 2015
What’s Up Wednesday is a monthly teleconference hosted by
Pennsylvania’s Blue Plans to help prepare health care professionals for
the ICD-10 transition on October 1, 2015. What’s Up Wednesday features
special guest speakers and ICD-10 experts who will lead discussions to
help you get ready for the compliance date. All providers, clearinghouses,
information trading partners, and information networks are encouraged to
participate.
How to participate
●● No registration is required. Prior to the call, visit the
What’s Up Wednesday web page at www.ibx.com/
providers/claims_and_billing/icd_10/whatsupweds.html
to access and download the presentation materials.
●● On the day of the call, dial 1-800-882-3610 and enter
pass code 5411307 when prompted. Please dial in
five minutes prior to the start of the call.
ICD-10
Will you
be ready?
Questions
If you have specific ICD-10-related questions
during the call, please email them to
[email protected]. 
Call details
Date: Wednesday, April 15, 2015
Time: 2 – 3 p.m. ET
Phone number: 1-800-882-3610
Pass code: 5411307
April 2015 | Partners in Health UpdateSM
4
www.ibx.com/providers
ICD-10
External testing update and tips for a successful conversion
Independence has begun testing with large health systems, which include hospitals, physicians, and clearing houses.
We will be communicating our testing experience and lessons learned to network providers to ensure a smooth
transition to ICD-10 by October 1, 2015.
Tips for a successful conversion
Steps you can take to ensure a successful transition to ICD-10:
1. Make a plan
●● Identify which ICD-9 codes you use heavily.
●● Identify staff that need to be trained in medical
coding and/or documentation.
●● Contact vendors to learn their transition plans, ICD-10
related costs to the practice, and resources available to
the practice.
●● Contact the specialty societies or the Centers for
Medicare & Medicaid Services (CMS) website for
any resources available to the practice.
2. Get trained
●● Buy or download an ICD-10 diagnosis codebook.
●● Arrange and obtain documentation training for
physicians and other clinicians.
●● Crosswalk common diagnosis codes to ICD-10
and identify new requirements or differences in
essential documentation.
●● Sign up for key CMS webinars to increase
understanding of the ICD-10 environment.
3. Update internal practice tools
●● Convert superbills to ICD-10.
●● Convert other materials to ICD-10, such as
authorizations, orders, and referrals.
●● Identify current code-related claim denials and areas
where ICD-10’s specificity in documentation and code
assignment can address this.
●● Obtain payer medical polices with ICD-10 codes for
comparison.
5. Test the process
●●
●●
●●
●●
Perform testing on systems within the practice.
Perform end-to-end testing, where available.
Identify and correct issues encountered during testing.
Educate staff on the impact of ICD-10 to payer edits,
adjudication, and other claims elements to processes
within the practice.
4. Work with vendors and payers
●● Arrange and implement ICD-10 software
upgrades and training for staff on use of new
software, either directly or via the vendor.
●● Identify electronic health records documentation
templates and assess how they support ICD-10
specificity for claims submission and medical
necessity.
●● Engage payers on any discrepancies and
omissions in ICD-10 coding for medical policies.
●● Identify if payers anticipate any changes in
processing and payments due to ICD-10.
For the most up-to-date information, including updates on external testing, frequently asked questions, and
dial-in information for the next What’s Up Wednesday call, please visit our dedicated ICD-10 web page at
www.ibx.com/icd10 and be sure to read future editions of Partners in Health Update. 
April 2015 | Partners in Health UpdateSM
5
www.ibx.com/providers
BILLING
EDI web resources updated
We recently updated our online resources for information related to electronic data interchange (EDI).
Independence provider EDI page
Now when you go to www.ibx.com/edi, you’ll see a brief overview and steps for getting started with EDI. On the right
side of the page, you’ll see a blue box called EDI Resources, which contains the following for download and viewing:
●● frequently asked questions about EDI
●● payer ID grids (professional and facility)
●● companion guide
The EDI web page is intended to provide a few key resources for submitting claims to Independence. It also contains
a link to the Trading Partner Business Center, our online resource for tools and documentation related to conducting
EDI business with Independence.
continued on the next page
April 2015 | Partners in Health UpdateSM
6
www.ibx.com/providers
BILLING
continued from the previous page
Trading Partner Business Center
The Trading Partner Business Center is available at www.highmark.com/edi-ibc. Launched in 2013, it was recently
revamped to make it easier to use to find information and resources.
The updated left-hand menu contains the following options:
●● Sign up. This link provides information for how to sign up as a trading partner to do business with Independence.
●● Update Trading Partners. The forms within this menu option are for requesting changes to a trading partner profile,
including changes to provider affiliation, trading partner contact information, and trading partner set-up.
●● Resources. This page includes many tools to assist trading partners in doing business with Independence,
including sample transactions, communication standards, and information about registration for electronic funds
transfer (EFT).
●● News. Included within this option is information about scheduled system outages and a list of corporate holidays.
If you have any questions related to EDI, please call Highmark EDI Operations at 1-800-992-0246.
Highmark EDI Operations is available Monday through Friday, 8 a.m. to 5 p.m., ET. 
April 2015 | Partners in Health UpdateSM
7
www.ibx.com/providers
BILLING
Updated process for submitting an overpayment/refund
request
If your office receives an overpayment from Independence and you need to submit an adjustment to correct the
overpayment, you can do so in one of the following ways.
The NaviNet® web portal
Participating providers with access to NaviNet should initiate an adjustment to correct an overpayment by selecting
the Claim Inquiry and Maintenance transaction and then Claim Status Inquiry. From there you can enter one of the
two appropriate search criteria options:
●● Billing Provider/Member ID/Date of Birth
●● Billing Provider/Member Last Name/First Name/Date of Birth
Once the search is complete, you can find a link to Claim Investigation through the Claims Search Results and Claim
Details screens. Through the Claim Investigation link you can submit the credit and/or retraction request, which will
appear on a future Provider Explanation of Benefits (Provider EOB) or Provider Remittance.
Overpayment/Refund Form
Offices that are nonparticipating with Independence or not
yet NaviNet-enabled can submit their adjustment request
using the Overpayment/Refund Form, which is located at
www.ibx.com/providerforms. Once the form has been completed,
please mail it, along with a copy of the Provider EOB or Provider
Remittance, to:
Independence Claims Overpayment
1901 Market Street, 39th Floor
Treasury Services – Misc. Cash Receipts
Philadelphia, PA 19103-1480
Note: The submission address for the Overpayment/Refund Form
recently changed. Please ensure you are using the most recent
version of the form.
If you have any questions regarding submitting an overpayment
request, please contact Customer Service. 
April 2015 | Partners in Health UpdateSM
8
www.ibx.com/providers
BILLING
Correction: Claim submission requirements when billing
with place of service code 22
This article contains corrections to the field requirements for electronically submitted claims that appeared in the
March 2015 edition of Partners in Health Update. This article was also designated for both professional and facility
provider types; however, it was intended for professional and ancillary providers. We apologize for any confusion
this may have caused.
When billing with place of service code 22, outpatient hospital, it is important to remember that you must complete all
required fields in their entirety, specifically as it relates to the Servicing Facility field. It is important that the proper ZIP
code is included to receive accurate payment.
Required fields
For claims submitted electronically:
●● Loop 2310C NM1 (Service Facility
Location Name)
—— N3 (Service Facility Location Address)
—— N4 (Service Facility Location City, State,
ZIP Code)
—— REF (Service Facility Location
Secondary Identification)
For claims submitted on paper:
●● Box 32 (see image, right)
Completing all required fields facilitates the
submission of a Clean Claim as contractually
required.
For complete information on submitting
claims electronically, refer to the EDI section
of our website at www.ibx.com/edi. For
complete information on submitting paper
claims, please read the Claims Submission
Toolkit for Proper Electronic and Paper
Claims Submission available at www.ibx.
com/providers/claims_and_billing/claims_
resources_guides.html. 
April 2015 | Partners in Health UpdateSM
9
www.ibx.com/providers
MEDICAL
NaviNet® to provide direct access link to CareCore’s
provider portal
As previously communicated, providers are required to obtain precertification through CareCore National, LLC
(CareCore), an independent company, for non-emergent outpatient radiation therapy services for all commercial and
Medicare Advantage HMO, POS, and PPO members. In addition, we will transition to the use of CareCore Radiation
Therapy Utilization Management Criteria when reviewing requests for radiation therapy services starting May 1, 2015.
For members under age 19, services requested will always be automatically approved; however, precertification
through CareCore is still required to ensure accurate and timely claims payment.
Effective May 1, 2015, the NaviNet web portal will offer direct access to CareCore’s provider portal to streamline the
process of obtaining precertification. Providers can select CareCore from the Authorizations transaction and will be
automatically redirected to CareCore’s provider portal without having to re-enter login credentials. Previous credentials
used to access CareCore’s provider portal are no longer needed when going through NaviNet.
Additional enhancements to NaviNet, including the ability to review finalized precertifications for radiation therapy
services precertified by CareCore, will be announced via NaviNet Plan Central later this month.
Precertification guidelines
The criteria that will be used as the basis for reviewing precertification requests as of May 1, 2015, are available on
CareCore’s website at https://www.carecorenational.com/benefits-management/radiation-therapy/radiation-therapytools-and-criteria.aspx.
In addition, the following medical policies include a link to the criteria that CareCore will use to determine medical
necessity for radiation therapy services as well as a complete list of procedure codes that require precertification:
●● Commercial: #09.00.56: Radiation Therapy Services;
●● Medicare Advantage: #MA09.020: Radiation Therapy Services.
To view these policies, visit our Medical Policy Portal at www.ibx.com/medpolicy. Select Accept and Go to Medical
Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page, depending on the
version of the policy you’d like to view. Type the policy name or number in the Search field.
Requesting precertification
You can initiate precertification for non-emergent outpatient radiation therapy in one of the following ways:
●● NaviNet. Select CareCore from the Authorizations transaction.
●● Telephone. Call CareCore directly at 1-866-686-2649. 
Medical and claim payment policy activity posted from
February 21 – March 23, 2015
Each month, new policy activity is posted to our Medical
Policy Portal. Policy activity may include new, updated,
reissued, or archived policies and coding updates.
Included with this edition of Partners in Health Update
is a supplementary listing of policy activity that occurred
for our commercial and Medicare Advantage Benefits
Programs from February 21 – March 23, 2015.
April 2015 | Partners in Health UpdateSM10
For the most up-to-date information about medical
and claim payment policy activity, go to www.ibx.com/
medpolicy and select Accept and Go to Medical Policy
Online. Then select either the Commercial or Medicare
Advantage tab from the top of the page, depending on
the version of the policy you’d like to view. You can also
get to our Medical Policy Portal through the NaviNet® web
portal by selecting the Reference Tools transaction, then
Medical Policy. 
www.ibx.com/providers
QUALITY MANAGEMENT
Highlighting HEDIS®: Well-child visits in the first
15 months of life
This article series is a monthly tool to help physicians maximize patient health outcomes in accordance with
NCQA’s* HEDIS®† measurements for high quality care on important dimensions of services.
Go to www.ibx.com/providers/resources/hedis.html to view previously published Highlighting HEDIS® topics.
If you have feedback or would like to request a topic, email us at [email protected].
HEDIS® definition
Well-child visits in the first 15 months of life: The percentage of members who turned 15 months old during the
measurement year and who had the following number of well-child visits with a primary care physician during their first
15 months of life:
●● no well-child visits
‡
●● one well-child visit
●● two well-child visits
Well-child visits in the first 15
●● three well-child visits
months of life is a performance
●● four well-child visits
measure in the Quality Incentive
●● five well-child visits
Payment System (QIPS)
program for measurement year
●● six or more well-child visits
2015 for participating providers.
QIPS alert
Why this measure is important
The American Academy of Pediatrics recommends six well-child visits in the first year of life: the first within the first
month of life, and then again at around two, four, six, nine, and twelve months of age. These visits are of particular
importance during the first year of life, when an infant undergoes substantial changes in abilities, physical growth,
motor skills, hand-eye coordination, and social and emotional growth. Regular check-ups are one of the best ways to
detect physical, developmental, behavioral, and emotional health problems. — NCQA, HEDIS 2015 V1
Plan performance
The chart below compares the national average for six
or more well-child visits in the first 15 months of life for
commercial HMO/PPO plans vs. Independence’s rates
over a four-year period.
Commercial
Year
National
Independence
HMO
PPO
HMO
PPO
2013
79.0%
76.9%
78.2%
83.6%
2012
78.2%
76.4%
76.2%
83.0%
2011
78.0%
76.1%
70.5%
61.2%
2010
76.3%
72.8%
76.1%
75.2%
As the chart demonstrates, Independence performs below
the national average for HMO and above the national
average for PPO. The goal for Independence is to reach
the national 90th percentile benchmark, which is currently
at 89.8 percent and 86.9 percent for HMO and PPO plans,
respectively. — Source: 2014 State of Health Care (NCQA) 
Quick tips for improvement
99Schedule the entire suite of visits with
or at the conclusion of the first visit.
99Inform caregivers on the importance of
well-child visits.
99Be proactive – make outreach calls
to members who are not on track to
complete the recommended six visits.
*The National Committee for Quality Assurance (NCQA) is the most
widely recognized accreditation program in the U.S.
†The Healthcare Effectiveness Data and Information Set (HEDIS) is
an NCQA tool used by more than 90 percent of U.S. health plans to
measure performance on important dimensions of care.
‡ QIPS is a reimbursement system developed by Keystone Health
Plan East for participating Pennsylvania primary care physicians that
offers incentives for high-quality, accessible, and cost-effective care.
April 2015 | Partners in Health UpdateSM11
www.ibx.com/providers
QUALITY MANAGEMENT
Independence’s Medicare utilization remains within
national standards
As part of Independence’s annual review process, we obtain data from the Healthcare Effectiveness Data and
Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) to help
evaluate utilization for our Medicare Advantage HMO and PPO members. The results showed that utilization remains
within national standards and members do not perceive significant barriers to getting appropriate care.
HEDIS® data evaluation
Independence used the data from HEDIS® to evaluate hospital discharges and the frequency rates of select cardiac
procedures.
Hospital utilization
Hospital utilization comparisons of acute discharges per 1,000 (Table 1) show that Keystone 65 HMO and Personal
Choice 65SM PPO rates continue to improve and remain within the relevant national 10th and 90th percentiles as the
appropriate thresholds for over/under utilization. Comparison of HEDIS® rates for Keystone 65 HMO reports a point
change from 2013 to 2014 of 2.71 but an overall downward trend for the last three measurement years; comparison
of HEDIS® rates for Personal Choice 65SM PPO reports a point change of -20.01 from HEDIS® 2013 to 2014, with a
downward trend over the last three measurement years.
Table 1: Hospital utilization comparison acute discharges per 1,000
HEDIS®
year
Point
change
2013 – 2014
R-squared
Trending
per 1000
members
Within
2.71
71.42%
Down
Within
-20.01
99.70%
Down
2012
2013
2014
Rate
Rate
Rate
Threshold
Threshold
status
Keystone 65
HMO
346.31
286.89
289.60
170.83 –
334.11
Personal
Choice 65
PPO
301.65
277.40
257.39
170.83 –
334.11
Use of services
Independence also measured the frequency of selected procedure rates for cardiac angioplasty, cardiac
catheterization, and coronary artery bypass graft (CABG). Based on a comparison of 2014 HEDIS® utilization rates
with respect to established thresholds, utilization for use of services for these identified indicators fell within the
established threshold for most age/gender cohorts. There were two cohorts that did not fall within national or regional
thresholds and one cohort that fell above national, but within regional thresholds. These rates are measured according
to age group and gender, and Independence recognizes the probability of unequal variance as an issue with the
cardiac procedure rates.
continued on the next page
April 2015 | Partners in Health UpdateSM12
www.ibx.com/providers
QUALITY MANAGEMENT
continued from the previous page
CAHPS data evaluation
Independence used CAHPS data to evaluate composite care, including member perception of getting needed care in
a timely manner and specialty care.
Keystone 65 HMO
The rates for Keystone 65 HMO members getting needed care during 2014 (Table 2) remains within the national
average. The point difference for members with Keystone 65 HMO CAHPS from 2013 to 2014 reports a change of
-0.09 for all indicators measured for this report and shows a downward trend over the last three reporting years
(2012 – 2014). The plan recognizes the difficulty in obtaining care and continues to actively recruit health care
providers within the region, including reaching out to network providers via the Clinical Quality Committee for input
into barriers to care that the plan may influence.
Table 2: CAHPS member satisfaction data — Keystone 65 HMO
HEDIS®
year
Point
change
2013 – 2014
R-squared
Three-year
trend
Within
-0.09
42.86%
Down
3.53
Within
-0.09
42.86%
Down
3.29
Within
-0.09
42.86%
Down
2012
2013
2014
Rate
Rate
Rate
National
average
Threshold
status
In the last six
months, how
often was it easy
to get care, tests,
or treatment
you thought you
needed?
3.64
3.67
3.58
3.57
In the last six
months, how
often was it
easy to get
appointments with
a specialist?
3.61
3.64
3.55
Getting needed
care composite
3.64
3.67
3.34
continued on the next page
April 2015 | Partners in Health UpdateSM13
www.ibx.com/providers
QUALITY MANAGEMENT
continued from the previous page
Personal Choice 65 PPO
The rate for Personal Choice 65 PPO members during 2014 (Table 3) for obtaining needed care, tests, and treatment
and overall care composite increased from CAHPS 2013 to 2014 and is significantly above the national average as
reported by the Centers for Medicare & Medicaid Services.
Personal Choice 65 PPO members are not required to identify a primary care physician, and many PPO members
with chronic conditions use a specialist as their primary physician. However, based on member responses regarding
the ease of care and care composite, there were no significant barriers to members receiving appropriate care noted.
Table 3: CAHPS member satisfaction data — Personal Choice 65 PPO
HEDIS®
year
2014
Point
change
2013 –
2014
R-squared
Three-year
trend
2012
2013
Rate
Rate
Rate
National
average
Threshold
status
In the last six
months, how
often was it easy
to get care, tests,
or treatment
you thought you
needed?
3.61
3.64
3.73
3.57
Above*
0.09
92.31%
Up
In the last six
months, how
often was it
easy to get
appointments with
a specialist?
3.61
3.61
3.52
3.53
Within
-0.09
75.00%
Down
Getting needed
care composite
3.61
3.61
3.37
3.29
Above*
0.03
75.00%
Up
*Threshold status significantly better/worse than the national average
For more information
To learn more about HEDIS®, go to www.ibx.com/providers/resources/hedis.html to view Highlighting HEDIS® articles
that have been published in Partners in Health Update. These articles are educational resources for understanding
HEDIS® measures. If you have feedback about the Highlighting HEDIS® series or topic requests, please email us at
[email protected]. 
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.
April 2015 | Partners in Health UpdateSM14
www.ibx.com/providers
QUALITY MANAGEMENT
Improving lead testing among CHIP members
Last year, Independence reminded Keystone Health Plan East practitioners of the importance of testing children
enrolled in the Pennsylvania Children’s Health Insurance Program (CHIP) for Elevated Blood Lead Level (EBLL). This
year, we again would like to take the opportunity to remind your practice that some of our CHIP population may reside
in homes that place them at risk for EBLL. As such, we’re providing you with an update on how your practice can
identify CHIP members and continue to evaluate their need for testing.
During 2013, the Pennsylvania Insurance Department reiterated to health plans the importance of increasing rates
for lead testing among CHIP members. Independence shared with practitioners the Centers for Disease Control and
Prevention’s (CDC) updated recommendation for prevention of lead poisoning and a new reference level of 5μg/dL to
identify children and environments associated with lead-exposure hazards.
In accordance with the Pennsylvania Insurance Department and Healthcare Effectiveness Data and Information Set
(HEDIS®) specification, children who are enrolled in CHIP follow the same guidelines for lead testing as children who
are enrolled in the Medicaid program; therefore, they should receive at least one lead capillary or venous blood test on
or before their second birthday.
Important update: Identifying CHIP members
In December 2014, the parents and guardians of CHIP members received a new Keystone Health Plan East ID card
with a new member ID number and instructions to begin using the new cards effective January 1, 2015. To ensure the
records of CHIP members are updated and the children receive correct coverage, parents were instructed to use the
new ID card each time their children receive medical services and when filling a prescription at the pharmacy.
The new Independence member ID cards still include the identifying words “PA KIDS” written on the front, as shown in
the sample CHIP ID card displayed below.
L
NaviNet® enhancements
Enhancements are being made to the NaviNet web portal to give providers the ability to identify CHIP members
through the PCP CAP Rosters transaction under ePayment.
In the meantime, providers should continue to identify CHIP members by using their ID cards. In addition, a list of
CHIP members will also be mailed to Keystone Health Plan East primary care physicians.
Additional information about this enhancement will be provided in future editions of Partners in Health Update. To
learn more about changes to NaviNet, we strongly encourage you to review the NaviNet Transaction Changes section
of our Business Transformation site at www.ibx.com/pnc/businesstransformation, which includes User Guides and a
complete archive of communications.
continued on the next page
April 2015 | Partners in Health UpdateSM15
www.ibx.com/providers
QUALITY MANAGEMENT
continued from the previous page
What practices can do: Lead testing vs. screening
Lead testing is described as one or more lead capillary or venous blood test for lead poisoning administered by a
child’s second birthday. Lead screening is described as an assessment or questionnaire regarding a child’s health or
living environment. While the terminologies are sometimes used interchangeably, lead screening is not the same as
lead testing.
Practitioners are asked to test children enrolled in the CHIP program between ages 9 to 12 months, again at 24
months, and thereafter based on risk. All CHIP members should be tested for EBLL regardless of risk level. A risk
assessment should be performed starting at 6 months, then again at 9 and 18 months, then annually from ages 3 to 6
with testing as appropriate.
Your personal recommendation has tremendous influence on the parents/guardians of your pediatric patients and
their decision to seek lead testing information for their children. Therefore, we respectfully ask for your practice’s
participation in ensuring that all CHIP members receive lead testing as appropriate.
The following resources provide additional information regarding lead testing recommendations:
●● CDC: www.cdc.gov/nceh/lead/nlppw.htm
●● Philadelphia Department of Public Health: 215-685-2788 (Philadelphia residents)
●● National Lead Information Center: 1-800-424-LEAD (non-Philadelphia residents)
●● U.S. Environmental Protection Agency: www.epa.gov 
NAVINET®
User guides and webinar now available for recent NaviNet
transaction changes
As previously communicated, significant changes were made in March to the NaviNet® web portal. We encourage you
to review the new user guides and webinar listed below, which are posted in the NaviNet Transaction Changes section
of our Business Transformation site at www.ibx.com/pnc/businesstransformation.
●● NaviNet Office Conversion Guide and webinar
●● Tiering Enhancement Guide
●● Allowance Inquiry Guide
●● Network Facility Inquiry Guide
●● Network Provider Inquiry Guide
If you have questions after reviewing these resources, please call the eBusiness Hotline at 215-640-7410.
Later this month, we will introduce a new transaction – Cash Management – that provides you with a weekly payment
accumulation and summary of payments received for the current year. More information about this new transaction
will be posted to Independence NaviNet Plan Central in the coming weeks. 
April 2015 | Partners in Health UpdateSM16
www.ibx.com/providers
HEALTH AND WELLNESS
Know your terms
The National Institutes of Health (NIH) wants your expectant patients to be aware of the new full-term pregnancy
definition and the importance of waiting for delivery until 39 weeks when possible. The following new terms reflect the
latest research regarding gestational age:
●● Early term: 37 weeks through 38 weeks and six days
●● Full term: 39 weeks through 40 weeks and six days
●● Late term: 41 weeks through 41 weeks and six days
●● Post term: 42 weeks and beyond
The NIH encourages providers to explain the critical development of the brain, lungs, and liver that babies
experience between 37 and 39 weeks and to share the risks of elective delivery before full term. Expectant
parents should also know that risks to both mother and baby are higher during this time period. As the
American Congress of Obstetricians and Gynecologists (ACOG) and Independence have already encouraged,
please do NOT schedule elective deliveries prior to 39 weeks gestation. Learn more by reviewing the
ACOG and Society for Maternal-Fetal Medicine Committee Opinion #579 “Definition of Term Pregnancy” at
http://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co579.pdf.
Free educational materials, developed by the Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) and National Child and Maternal Health Education Program (NCMHEP) are
available to help you share this important message with your expectant patients. To order these materials, go to
www.nichd.nih.gov/ncmhep/terms/ordermaterials. 
Free mobile health tool for your patients: CareCam app now
available for diabetes and asthma self-management
As part of our ongoing commitment to help
members improve their health, beginning April 1,
2015, Independence is offering a new chronic care
management app to diabetic and asthmatic members
through CareCam Health Systems (CCHS), an
independent vHealthTM technology firm. The CareCam
app can be downloaded by your Independence diabetic
and asthmatic patients to their smartphone or tablet
for free and is designed to help them comply with
your recommended care plan between appointments.
Trial participants viewed CareCam as a helpful coach
and trusted source of condition-specific education
and reported increased feelings of independence and
accountability. CareCam also received positive feedback
from physician focus group participants.
April 2015 | Partners in Health UpdateSM17
The app helps your patients customize a daily schedule of
health care activities, based around the recommendations
you provide during visits. Patients receive reminders for
late or missed activities and personalized feedback on
their results. Patients can access condition-specific video
education and summaries of past results to share with
you during appointments. CareCam users can also invite
friends or family members to follow their progress and
provide support and encouragement.
CareCam requires no action from physicians except to
direct Independence diabetic and asthmatic patients to
search “CareCam’’ in the Apple App Store or Google
Play Store to download the app for free. Note: During
registration some patients may be required to call
CareCam to validate their eligibility. 
www.ibx.com/providers
Important Resources
Anti-Fraud and Corporate Compliance
Hotline
1-866-282-2707 or www.ibx.com/antifraud
Care Management and Coordination
Baby BluePrints®
215-241-2198 / 1-800-598-BABY (2229)*
Case Management
1-800-313-8628
Condition Management Program
1-800-313-8628
Credentialing
Credentialing Violation Hotline
215-988-1413 or www.ibx.com/credentials
Customer Service/Provider Services
Provider Automated System
1-800-ASK-BLUE (1-800-275-2583)
Provider Services user guide
www.ibx.com/providerautomatedsystem
Electronic Data Interchange (EDI)
Highmark EDI Operations
1-800-992-0246
FutureScripts® (commercial pharmacy benefits)
Prescription drug prior authorization
1-888-678-7012
Pharmacy website (formulary updates, prior authorization)
www.ibx.com/rx
FutureScripts® Secure (Medicare Part D pharmacy benefits)
FutureScripts Secure Customer Service
Formulary updates
1-888-678-7015
www.ibxmedicare.com
NaviNet® web portal
Independence eBusiness Hotline
Registration
215-640-7410
www.navinet.net
Other frequently used phone numbers and websites
Independence Direct Ship Injectables Program (medical benefits)
www.ibx.com/directship
Medical Policy
www.ibx.com/medpolicy
Provider Supply Line
1-800-858-4728 or www.ibx.com/providersupplyline
*Outside 215 area code
Visit our Provider News Center:
www.ibx.com/pnc
Medical and claim payment policy activity
Commercial business
The following pages list the policy activity for commercial business that we have posted to our Medical Policy Portal
from February 21 – March 23, 2015.
For the most up-to-date information about medical and claim payment policy activity for commercial business, go to
www.ibx.com/medpolicy, select Accept and Go to Medical Policy Online, and then select the Commercial tab. You can
also view policy activity using the NaviNet® web portal by selecting the Reference Tools transaction, then Medical Policy.
New policies
The following commercial policies have been newly developed to communicate coverage and/or reimbursement positions,
reporting requirements, and other processes and procedures for doing business with Independence.
Policy #
Title
Notification date Effective date
00.01.61
Reimbursement for Components of Comprehensive Laboratory Panels
February 4, 2015
March 6, 2015
05.00.76
Breast Pumps
March 11, 2015
April 10, 2015
Updated policies
The following commercial policies have been reviewed and updated to communicate current coverage and/or
reimbursement positions, reporting requirements, and other procedures for doing business with Independence.
Policy #
Title
Type of policy change
Notification date Effective date
06.02.01f
Lyme Disease: Diagnosis and
Intravenous (IV) Antibiotic Treatment
Coverage and/or Reimbursement
Position; Medical Coding; General
Description, Guidelines, or Informational
Update
January 26, 2015
07.02.09c
Ambulatory Blood Pressure
Monitoring (ABPM)
Medical Necessity Criteria; Medical
Coding; General Description, Guidelines, February 23, 2015
or Informational Update
March 25, 2015
08.00.26s
Botulinum Toxin Agents
General Description, Guidelines, or
Informational Update
February 9, 2015
March 11, 2015
08.00.50m
Rituximab (Rituxan )
Coverage and/or Reimbursement
Position; Medical Necessity Criteria;
Medical Coding; General Description,
Guidelines, or Informational Update
N/A
March 11, 2015
08.00.79a
Plerixafor Injection (Mozobil™)
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
08.01.10a
Octreotide acetate (Sandostatin®
LAR Depot)
Medical Necessity Criteria; Medical
Coding
N/A
February 25, 2015
09.00.02e
Electron Beam Computed
Tomography (EBCT) for Screening
Evaluations
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
09.00.40d
Screening for Vertebral Fracture
with Dual-Energy X-ray
Absorptiometry (DEXA/DXA)
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
09.00.42c
Computer-Aided Detection
(CAD) System for use with Chest
Radiographs
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
®
February 21 – March 23, 2015
February 25, 2015
1
Policy #
Title
Type of policy change
Notification date Effective date
09.00.49g
Proton Beam Radiation Therapy
Coverage and/or Reimbursement
Position; Medical Necessity Criteria
May 1, 2015
December 31, 2014 Revised
March 4, 2015
11.01.02k
Cochlear Implant
Medical Necessity Criteria; Medical
Coding; General Description, Guidelines, February 25, 2015
or Informational Update
11.01.06b
Coverage and/or Reimbursement
Bone-Anchored (Osseointegrated)
Position; Medical Necessity Criteria;
Hearing Aids and Implantable Middle
General Description, Guidelines, or
Ear Hearing Aids
Informational Update
11.06.05c
Endometrial Ablation
11.06.07c
March 27, 2015
February 5, 2015
May 6, 2015
Coverage and/or Reimbursement
Position; Medical Necessity Criteria;
Medical Coding; General Description,
Guidelines, or Informational Update
N/A
March 4, 2015
Ovarian and Internal Iliac Vein
Embolization as Treatment for
Pelvic Congestion Syndrome
General Description, Guidelines, or
Informational Update
N/A
March 18, 2015
11.08.17e
Debridement of Mycotic and
Symptomatic Non-Mycotic
Hypertrophic Toe Nails
Medical Necessity Criteria; Medical
Coding; General Description, Guidelines, February 23, 2015
or Informational Update
March 25, 2015
11.11.01g
Evaluation and Treatment of
Erectile Dysfunction (ED)
Medical Necessity Criteria
March 5, 2015
June 3, 2015
11.14.02j
Trigger Point Injections
Medical Coding
N/A
March 4, 2015
11.14.13f
Extracorporeal Shock
Wave Therapy (ESWT) for
Musculoskeletal Conditions
General Description, Guidelines, or
Informational Update
N/A
February 25, 2015
11.15.22c
Percutaneous Image-Guided
Lumbar Decompression (PILD) for
Spinal Stenosis
General Description, Guidelines, or
Informational Update; Medical Coding
N/A
February 25, 2015
11.15.24a
Migraine Deactivation Surgery
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
11.17.06l
Surgical and Minimally Invasive
Treatments for Urinary Outlet
Obstruction due to Benign
Prostatic Hyperplasia (BPH)
Coverage and/or Reimbursement
Position; Medical Necessity Criteria
March 9, 2015
April 8, 2015
12.01.01ab
Experimental/Investigational
Services
Coverage and/or Reimbursement
Position; Medical Coding
March 2, 2015
April 1, 2015
Reissued policies
The following commercial policies have been reviewed, and no substantive changes were made.
Policy #
Title
Reissue
effective date
Reissue
published date
05.00.04c
Food and Drug Administration (FDA) Approval of Medical Devices
March 4, 2015
March 4, 2015
05.00.62g
Injectable Dermal Fillers
March 4, 2015
March 5, 2015
07.00.01f
Biofeedback Therapy
March 4, 2015
March 4, 2015
07.03.14i
Intraoperative Neurophysiological Monitoring (INM)
March 18, 2015
March 19, 2015
07.10.06b
Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation
March 4, 2015
March 4, 2015
07.11.01b
Smell and Taste Dysfunction Testing
March 18, 2015
March 19, 2015
07.13.08c
Partial Coherence Interferometry
March 4, 2015
March 4, 2015
09.00.51a
Positron Emission Mammography (PEM)
March 4, 2015
March 4, 2015
February 21 – March 23, 2015
2
Policy #
Title
Reissue
effective date
Reissue
published date
10.04.01k
Pulmonary Rehabilitation
March 4, 2015
March 4, 2015
11.05.10b
Reimbursement for a Presbyopia- or Astigmatism-Correcting Intraocular Lens
March 4, 2015
March 4, 2015
11.14.03e
Meniscal Allograft Transplantation
March 18, 2015
March 19, 2015
11.15.13c
Lysis of Epidural Adhesions
March 4, 2015
March 4, 2015
11.15.19e
Nucleoplasty
March 4, 2015
March 4, 2015
11.16.03f
Lung Volume Reduction Surgery
March 4, 2015
March 4, 2015
Coding updates
The following commercial policies have been reviewed and updated to add new and revised medical codes (e.g., ICD-9
and ICD-10 diagnosis codes; CPT® and HCPCS codes; revenue codes) and/or remove terminated medical codes.
Policy #
Title
Effective date
Published date
00.03.02s
Diagnostic Radiology Services Included in Capitation
January 1, 2015
February 6, 2015
Revised
March 18, 2015
00.10.01u
Services Paid Above Capitation for Health Maintenance Organization (HMO)
Primary Care Physicians
January 1, 2015
February 24, 2015
03.00.10l
Modifiers LT/RT: Left Side/Right Side Procedures
January 1, 2015
March 20, 2015
08.00.92m
Coagulation Factors for Hemophilia
April 1, 2015
March 20, 2015
09.00.32l
Diagnostic and Therapeutic Radiopharmaceutical Agents
January 1, 2015
March 20, 2015
11.00.10r
Multiple Surgical Reduction Guidelines
January 1, 2015
March 20, 2015
Archived policies
Independence has determined that it is no longer necessary for the following commercial policies to remain active.
Policy #
Title
Notification date
Archive
effective date
11.15.11b
Treatment for Hyperhidrosis (Nonpharmacologic)
March 11, 2015
April 10, 2015
11.17.07f
Radiofrequency Micro-remodeling (by transurethral, transvaginal, or
paraurethral approach) for Urinary Stress Incontinence
February 11, 2015
March 13, 2015
Continue to the next page for information
about Medicare Advantage policy activity.
February 21 – March 23, 2015
3
Medical and claim payment policy activity
Medicare Advantage business
The following pages list the policy activity for Medicare Advantage business that we have posted to our Medical Policy
Portal from February 21 – March 23, 2015.
For the most up-to-date information about medical and claim payment policy activity for Medicare Advantage business, go
to www.ibx.com/medpolicy, select Accept and Go to Medical Policy Online, and then select the Medicare Advantage tab.
You can also view policy activity using the NaviNet® web portal by selecting the Reference Tools transaction, then
Medical Policy.
New policy
The following Medicare Advantage policy has been newly developed to communicate coverage and/or reimbursement
positions, reporting requirements, and other processes and procedures for doing business with Independence.
Policy #
Title
Notification date
Effective date
MA01.006
Reimbursement for Components of Comprehensive Laboratory Panels
February 4, 2015
March 6, 2015
Updated policies
The following Medicare Advantage policies have been reviewed and updated to communicate current coverage and/or
reimbursement positions, reporting requirements, and other procedures for doing business with Independence.
Policy #
Title
Type of policy change
Notification date
Effective date
MA00.005a
Experimental/Investigational
Services
Coverage and/or Reimbursement
Position; Medical Coding
March 11, 2015
April 10, 2015
MA05.052a
Canes and Crutches
Medical Coding
N/A
March 18, 2015
MA06.006a
Lyme Disease: Diagnosis and
Intravenous (IV) Antibiotic Treatment
Coverage and/or Reimbursement
Position; Medical Coding; General
Description, Guidelines, or
Informational Update
January 26, 2015
February 25, 2015
MA08.003a
Enteral Nutritional Therapy
Medical Necessity Criteria
N/A
March 11, 2015
MA08.017a
Botulinulm Toxin Agents
General Description, Guidelines, or
Informational Update
February 9, 2015
March 11, 2015
MA08.022a
Rituximab (Rituxan )
Coverage and/or Reimbursement
Position; Medical Necessity Criteria;
Medical Coding; General Description,
Guidelines, or Informational Update
N/A
March 11, 2015
MA08.039a
Plerixafor Injection (Mozobil™)
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
MA08.065a
Octreotide Acetate (Sandostatin®
LAR Depot)
Medical Necessity Criteria;
Medical Coding
N/A
February 25, 2015
MA09.007a
Proton Beam Therapy
Coverage and/or Reimbursement
Position; Medical Necessity Criteria
February 12, 2015
May 1, 2015
Revised
March 4, 2015
MA09.011a
Electron Beam Computed
Tomography (EBCT) for Screening
Evaluations
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
MA09.013a
Screening for Vertebral Fracture
with Dual-Energy X-ray
Absorptiometry (DEXA/DXA)
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
®
February 21 – March 23, 2015
4
Policy #
Title
Type of policy change
Notification date
Effective date
MA09.014a
Computer Aided Detection
(CAD) System for use with Chest
Radiographs
General Description, Guidelines, or
Informational Update
N/A
March 11, 2015
MA11.004a
Surgical and Minimally Invasive
Treatments for Urinary Outlet
Obstruction due to Benign
Prostatic Hyperplasia (BPH)
Coverage and/or Reimbursement
Position; Medical Coding
March 9, 2015
April 8, 2015
MA11.014a
Debridement of Mycotic and
Symptomatic Non-Mycotic
Hypertrophic Toe Nails
Medical Necessity Criteria; Medical
Coding; General Description,
Guidelines, or Informational Update
February 23, 2015
March 25, 2015
MA11.017a
Trigger Point Injections
Medical Coding
N/A
March 4, 2015
MA11.039a
Cochlear Implantation
Medical Necessity Criteria; Medical
Coding; General Description,
Guidelines, or Informational Update
February 25, 2015
March 27, 2015
MA11.049a
Bone-Anchored (Osseointegrated)
Hearing Aids and Implantable
Middle Ear Hearing Aids
Coverage and/or Reimbursement
Position; Medical Necessity Criteria;
General Description, Guidelines, or
Informational Update
February 5, 2015
May 6, 2015
MA11.064a
Implantable Miniature Telescope™
(IMT) for the Treatment of EndStage Age-Related Macular
Degeneration (AMD)
Medical Necessity Criteria
January 15, 2015
April 15, 2015
MA11.065a
Endometrial Ablation
Coverage and/or Reimbursement
Position; Medical Necessity Criteria;
Medical Coding; General Description,
Guidelines, or Informational Update
N/A
March 4, 2015
MA11.066a
Ovarian and Internal Iliac Vein
Embolization as Treatment for
Pelvic Congestion Syndrome
General Description, Guidelines, or
Informational Update
N/A
March 18, 2015
MA11.079a
Evaluation and Treatment of
Erectile Dysfunction (ED)
Medical Necessity Criteria
March 5, 2015
June 3, 2015
MA11.087a
Extracorporeal Shock
Wave Therapy (ESWT) for
Musculoskeletal Conditions
General Description, Guidelines, or
Informational Update
N/A
February 25, 2015
MA11.097a
Percutaneous Image-Guided
Lumbar Decompression (PILD) for
Spinal Stenosis
Medical Coding
N/A
February 25, 2015
Reissued policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
Policy #
Title
Reissue
effective date
Reissue
published date
MA05.021
Injectable Dermal Fillers
March 4, 2015
March 5, 2015
MA05.040
Food and Drug Administration (FDA) Approval of Medical Devices
March 4, 2015
March 4, 2015
MA07.010
Biofeedback Therapy
March 4, 2015
March 4, 2015
MA07.021
Partial Coherence Interferometry
March 4, 2015
March 4, 2015
MA07.043
Smell and Taste Dysfunction Testing
March 18, 2015
March 19, 2015
MA07.051
Intraoperative Neurophysiological Testing
March 18, 2015
March 19, 2015
MA08.001
Vedolizumab (Entyvio )
March 18, 2015
March 19, 2015
MA09.015
Positron Emission Mammography (PEM)
March 4, 2015
March 5, 2015
MA10.001
Pulmonary Rehabilitation Services
March 4, 2015
March 5, 2015
®
February 21 – March 23, 2015
5
Policy #
Title
Reissue
effective date
Reissue
published date
MA11.003
Lung Volume Reduction Surgery (LVRS)
March 4, 2015
March 5, 2015
MA11.005
Deep Brain Stimulation (DBS)
March 18, 2015
March 19, 2015
MA11.043
Reimbursement for a Presbyopia- or Astigmatism-Correcting Intraocular Lens
March 4, 2015
March 5, 2015
MA11.053
Sterilization
March 4, 2015
March 4, 2015
MA11.081
Meniscal Allograft Transplantation
March 18, 2015
March 19, 2015
MA11.095
Lysis of Epidural Adhesions
March 4, 2015
March 5, 2015
MA11.098
Migraine Deactivation Surgery
March 4, 2015
March 5, 2015
MA11.101
Nucleoplasty
March 4, 2015
March 5, 2015
Coding updates
The following Medicare Advantage policies have been reviewed and updated to add new and revised medical codes (e.g.,
ICD-9 and ICD-10 diagnosis codes; CPT® and HCPCS codes; revenue codes) and/or remove terminated medical codes.
Policy #
Title
Effective date
Published date
MA00.027a
Diagnostic Radiology Services Included in Capitation
January 2, 2015
February 6, 2015
Revised
March 18, 2015
MA00.033a
Services Paid Above Capitation for Health Maintenance Organization
(HMO) Primary Care Physicians
January 2, 2015
February 24, 2015
MA03.006a
Modifiers LT/RT: Left Side/Right Side Procedures
January 2, 2015
March 20, 2015
MA08.004b
Coagulation Factors for Hemophilia
April 1, 2015
March 20, 2015
MA09.009a
Diagnostic and Therapeutic Radiopharmaceutical Agents
January 2, 2015
March 20, 2015
MA11.032a
Multiple Surgical Reduction Guidelines
January 2, 2015
March 20, 2015
Archived policies
Independence has determined that it is no longer necessary for the following Medicare Advantage policies to remain
active.
Policy #
Title
Notification date
Archive
effective date
MA11.038
Radiofrequency Micro-remodeling (by transurethral, transvaginal, or
paraurethral approach) for Urinary Stress Incontinence
February 11, 2015
March 13, 2015
MA11.094
Treatment for Hyperhidrosis (Nonpharmacologic)
March 11, 2015
April 10, 2015
NaviNet is a registered trademark of NaviNet, Inc., an independent company.
CPT copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
February 21 – March 23, 2015
6