Medical review is the collection of information and clinical review of medical records by physician advisors (for providers reviewing cases before submissions) or a peer review team (for payers) to ensure that payment is made only for services that meet coverage, coding, and medical necessity requirements.
What were the objectives of BCBS KC in building its CRM system?
With assistance from Lumeris to improve care coordination, Blue KC will be in a position to meet the industry’s goals of the Triple Aim plus One: improved quality, cost, and patient plus physician satisfaction.
Where is BCBS of Kansas City located?
Blue Cross Blue Shield of Kansas City 2301 Main St Kansas City, MO Insurance – MapQuest.
Who is the PBM for BCBS of Kansas City?
Starting January 1, 2020, OptumRx will be the pharmacy benefit manager (PBM) for Blue Cross Blue Shield of Kansas City (Blue KC) members. Express Scripts, the current PBM, will provide pharmacy services through December 31, 2019.
What is the purpose of a medical policy?
Medical policies are Plan documents used to support coverage decisions for specific medical, surgical, or dental procedures, and behavioral health services, drugs, other ancillary services or devices. Medical policies frequently address medical necessity or investigational status based on the contract definitions.
Does Blue Cross Blue Shield of Kansas cover therapy?
Does Blue Cross Blue Shield cover therapy? Yes, the vast majority of Blue Cross Blue Shield plans cover therapy.
Is OptumRx part of BCBS?
Blue Cross Blue Shield of Michigan chose OptumRx as its new pharmacy benefit provider, ending a relationship with Express Scripts, the insurer said Jan. 6.
What are Blue Cross and Blue Shield medical policies?
This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City (“BCBSKC”). Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. These Medical Policies describe when medical services are considered medically necessary, not medically necessary or investigational.
What is blueblue KC’s provider payment policy?
Blue KC has developed Provider Payment Policies to provide guidance on payment methodologies as they pertain to submitted claims. These policies are written following industry standard recommendations from sources such as:
What is medical policy?
By clicking on “I Agree” below, I acknowledge that I have read the following. This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City (“BCBSKC”). Medical policy determines if, and under what circumstances, medical services may be eligible for coverage.
How are provider service policies written?
These policies are written following industry standard recommendations from sources such as: Coverage of any service is determined by date of service, a member’s eligibility and benefit limits for the service or services rendered, all terms of the Provider Service Agreement, and other standards of coding rules and guidelines.
