April 2013www.ibx.com/providers

► Articles designated with an orange arrow include notice of changes or clarifications to administrative policies and procedures.

Inside this edition BUSINESS TRANSFORMATION

► Upcoming transition to a Primary Health Coach model

► Enrollment changes for Baby BluePrints®

MEDICAL

► Policy notifications posted as of March 28, 2013

ICD-10

► ICD-10 codes now available in medical and claim payment policies

► Putting ICD-10 into Practice: Coding exercises and scenarios

NAVINET®

► Available this month: The Comparative Procedure Costs tool

● NaviNet registration requirement now in effect

● Reminder: NaviNet Claim INFO Adjustment requirement

HEALTH AND WELLNESS

● Help Medicare-eligible patients prevent diabetes with SilverSneakers®

Enrollment changes for Baby BluePrints® page 5

Models are used for illustrative purposes only. Some illustrations in this publication copyright 2013 www.dreamstime.com. All rights reserved.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association.

The Blue Cross and Blue Shield names and symbols, and Baby BluePrints are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

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 IBC exercises no control, and accordingly, IBC 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 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Partners in Health UpdateSM is a publication of Independence Blue Cross and its affiliates (IBC), created to provide valuable information to the IBC-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 IBC. This publication is the primary method for communicating such general changes. Suggestions are welcome.

Contact information:

Provider CommunicationsIndependence Blue Cross1901 Market Street 27th FloorPhiladelphia, PA 19103

provider_communications@ibx.com

Personal Choice®, Keystone 65 HMO, and Personal Choice 65SM PPO have an accreditation status of Excellent from the National Committee for Quality Assurance (NCQA).

Keystone Health Plan East has an accreditation status of Commendable from NCQA.

For articles specific to your area of interest, look for the appropriate icon:

Professional

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Want to be notified directly about breaking news, publication releases and updates, and changes to our processes and procedures? If so, sign up to receive our provider email.

Email sign-up: www.ibx.com/providers/email

All requests are processed within 48 hours. To prevent your firewall from marking our email messages as spam, please add IBC (provider_communications@ibx.com) to your email address book and provide your information services or information technology contacts with the domains and IP addresses listed on our website.

For professional providers onlyAdditionally, the IBC Network Medical Directors offer a physician-to-physician email platform, that provides direct and succinct messaging intended to assist physicians in providing quality care to our members. Email topics have included information on the Quality Performance Measure (QPM) score program, announcements of new initiatives, fee schedule reminders, and more.

Participating professional providers are encouraged to join the Network Medical Directors Physician-to-Physician email list.

Physician-to-Physician email sign-up: www.ibx.com/providers/physician_email

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Business TransformaTion

Upcoming transition to a Primary Health Coach modelIBC will soon introduce a new approach to health coaching for our members, called the Primary Health Coach model. The new Primary Health Coach model gives members a single point of contact for all issues and concerns related to disease/condition and case management (this combination is called care management).

The following table describes our current care management programs and the changes that will be made as a result of this transition to the Primary Health Coach model:

Program description

Current programWhat will change with new model

ConnectionsSM Health Management Program

Disease/condition management that offers eligible members 24/7/365 access to a Health Coach by calling 1-800-ASK-BLUE

Program administered by Health Dialog, an independent company

Program will be administered by IBC Health Coaches

ConnectionsSM Complex Care Management Program

Supports eligible members who have one or more of 16 complex, chronic conditions

Support provided by IBC care management nurses

Program name will be discontinued, but support will continue to be provided by IBC Health Coaches

Case management

Provides members with extra support when dealing with an acute illness, chronic condition, or multiple comorbidities

Support provided by IBC care management nurses

Support will continue to be provided by IBC nurses, who will be called Health Coaches

Fully insured commercial and Medicare Advantage HMO and PPO members will transition to the new Primary Health Coach model on May 6, 2013, and IBC members from self-insured groups will transition on January 1, 2014.

continued on the next page

At IBC, we’re 75 years strong and still changing the game – enhancing the health and wellness of the people and communities we serve. Serving our members well means offering the right technology, tools, and processes, which is why we decided to migrate to a new operating platform.

The new operating platform will offer greater capabilities, increased flexibility in benefit design, and enhanced functionalities to improve the customer experience. This business transformation and migration to the new platform will occur throughout 2014 and into 2015.

IBC is committed to ensuring a seamless transition for our customers and other stakeholders through communication and tools to guide you through the migration process and dedicated teams of IBC associates who will work together to deliver integrated end-to-end solutions.

For more information about this transformation and how it may affect health care providers, please visit our dedicated site. Go to www.ibx.com/pnc and select Business Transformation from the top menu.

Changing the way we do business with you

April 2013 | Partners in Health UpdateSM 3 www.ibx.com/providers

Business TransformaTion

April 2013 | Partners in Health UpdateSM 4 www.ibx.com/providers

Benefits of a Primary Health Coach model include:

● The Health Coach remains consistent as members transition across the health care continuum. This consistency ensures patient-centered coaching that is individualized and coordinated.

● The Health Coach and member can develop a trusted relationship, which fosters higher levels of member engagement and helps members reach their health goals.

● A Health Coach will have a 360-degree view of a member’s complete health record using an integrated nurse dashboard, which puts information at the Health Coach’s fingertips. This display features information about the member’s condition, prescription drugs, recent diagnostic or therapeutic activities, and patterns of treatment and procedures. Such complete data review allows our Health Coaches to have a more meaningful interaction with a member and improves the customer experience.

What providers need to knowEffective May 1, 2013, providers should refer patients IBC for disease/condition and case management by submitting an online physician referral form, available at www.ibx.com/providerforms. A link to this form is also available on NaviNet® Plan Central in the Administrative Tools & Resources section. Providers who wish to refer their patients via telephone should call 1-800-ASK-BLUE.

Note: As of May 1, 2013, providers should no longer call the Provider Support Line (1-866-866-4694) to make patient referrals.

Effective May 1, 2013, the ConnectionsSM Provider Portal will be discontinued, and providers will no longer receive the SMART® Registry, which is an annual report offering a point-in-time snapshot about specific information on patients with chronic conditions. Instead, providers will continue to have access to similar information for their patients through our Clinical Alerts and the Clinical Care Report, both available on the NaviNet web portal through the Eligibility and Benefits Inquiry transaction.

What members need to knowMembers who currently use the disease/condition management program and who have a Health Coach under the current program will be transitioned to a new Health Coach at IBC. These members will be notified of this change by mail and assigned to a new IBC Health Coach.

Members should continue to call the same number (1-800-ASK-BLUE) to reach a Health Coach. Once they indicate that they would like to speak to a Health Coach, their call will be routed to a Health Coach at IBC. Members will continue to have 24/7/365 access to a Health Coach and online educational tools.

If you or one of your IBC patients has any questions about this change, please call Customer Service at 1-800-ASK-BLUE.

Upcoming transition to a Primary Health Coach model (continued)

Business TransformaTion

Enrollment changes for Baby BluePrints®

IBC will soon change the way members are enrolled in our Baby BluePrints maternity program. The overall goal of the Baby BluePrints program — to reach out to members who have been identified as having risk factors within their first trimester of pregnancy — is not changing.

Beginning May 6, 2013, when IBC maternity members come in for their first prenatal visit, they no longer need to complete the Initial Maternity Patient Questionnaire (IMPQ). Instead, we ask that you let them know about the Baby BluePrints program and encourage them to call our toll-free number, 1-800-598-BABY, to self-enroll. Upon calling, a Health Coach will explain the program to the member and ask her a series of questions to complete the enrollment process.

Once enrolled in the program, members will receive a welcome letter that includes information on how to access educational materials on our secure member website, ibxpress.com, and the 1-800-598-BABY phone number for questions and support during pregnancy. In addition, high-risk members will be given the name and contact information for their Health Coach.

If in subsequent prenatal visits you discover that a maternity member has not yet self-enrolled in Baby BluePrints, or you feel that she may benefit from case management due to a high-risk pregnancy, you can refer the member to the program by completing an online physician referral form, which is available at www.ibx.com/providerforms. When you submit the online referral form, we will make certain that members who need additional support are encouraged to enroll in case management. You can also call 1-800-ASK-BLUE to refer a high-risk maternity member for case management.

Changes in the prenotification processCurrently, once an IMPQ is submitted for a member, the submission generates a maternity prenotification number that providers can view through the NaviNet® web portal using the Authorizations transaction. With the discontinuation of the IMPQ, a prenotification number will no longer be generated. Therefore, as of May 6, 2013, you will no longer need to obtain prenotification or notify IBC of the delivery.

Note: Providers must continue to inform IBC of any OB antepartum admissions, any babies admitted to the neonatal intensive care unit (NICU), and any detained babies.

If you have any questions about these changes, please call Customer Service at 1-800-ASK-BLUE.

April 2013 | Partners in Health UpdateSM 5 www.ibx.com/providers

Please continue to enroll maternity members using the IMPQ until May 3, 2013.

April 2013 | Partners in Health UpdateSM 6 www.ibx.com/providers

All policies are posted prior to their effective date. Below is a listing of the policy notifications that we have posted to our website as of March 28, 2013.

Policy effective date Policy No. Notification titleNotification issue date

March 29, 2013 08.01.05 Carfilzomib (Kyprolis™) February 27, 2013

March 29, 2013 08.01.09 Omacetaxine mepesuccinate (Synribo®) February 27, 2013

April 1, 2013 05.00.58f Home Oxygen Therapy February 28, 2013

April 1, 2013 09.00.53Magnetic Resonance Imaging (MRI) for Monitoring the Integrity of Silicone-Gel-Filled Breast Implants in Asymptomatic Individuals

March 1, 2013

April 2, 2013 11.14.08c Orthognathic Surgery January 2, 2013

April 2, 2013 08.00.81b Bendamustine Hydrochloride (Treanda®) January 2, 2013

April 2, 2013 11.14.03e Meniscal Allograft Transplantation January 2, 2013

April 4, 2013 08.00.25gTreatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents Intended for Home Use

January 4, 2013

April 16, 2013 07.02.07g Ambulatory, Real-Time Cardiac Surveillance System January 16, 2013

April 16, 2013 11.05.02gBlepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy

January 16, 2013

April 17, 2013 11.15.09dDenervation of the Spinal Nerves for Chronic Facet Pain

January 17, 2013

May 11, 2013 11.14.25a Total Ankle Arthroplasty/Replacement March 13, 2013

To view the policy notifications, go to www.ibx.com/medpolicy, select Accept and Go to Medical Policy Online, and click on the Policy Notifications box. You can also view policy notifications using the NaviNet® web portal by selecting Reference Tools from the Plan Transactions menu, then Medical Policy. Once these policies are in effect, they will be available by using the Search box on the Medical Policy homepage. Be sure to check back often, as the site is updated frequently.

medical

Policy notifications posted as of March 28, 2013

April 2013 | Partners in Health UpdateSM 7 www.ibx.com/providers

As you know, the International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes will become effective October 1, 2014. All covered entities must comply with ICD-10 — one of the biggest mandated medical data code set initiatives — by this date. IBC continues to work on the transition from ICD-9 to ICD-10.

To help ease the transition and familiarize you with the differences in the coding structure, IBC has begun to add ICD-10 procedure and diagnosis codes to medical and claim payment policies. As new policies are written and existing policies are reviewed and updated, certified medical coders will assess each IBC policy and add ICD-10 codes. While the ICD-10 codes are not in effect until 2014, you will be able to see how ICD-10 codes will appear in our policies and how they differ from the ICD-9 codes.

Please note that the ICD-10 codes included in IBC policies are for informational purposes only. Please do not begin reporting ICD-10 codes on claims submitted until October 1, 2014.

Accessing ICD-10 codesThe ICD-10 codes appear in the Coding Table section of medical and claim payment policies and can be viewed either as a single list or in a side-by-side table with ICD-9 codes. To view the ICD-10 codes as a single list, go to the Coding Table, choose either the ICD Procedure or ICD Diagnosis tab, and select the ICD-10 button within the ICD Diagnosis Code Number(s) and Narrative(s) heading. See the example to the right for Medical Policy #08.00.99a: Belimumab (Benlysta®).

continued on the next page

ICD-10 codes now available in medical and claim payment policies

April 2013 | Partners in Health UpdateSM 8 www.ibx.com/providersApril 2013 | Partners in Health UpdateSM 8 www.ibx.com/providers

ICD-10 codes now available in medical and claim payment policies (continued)

To view ICD-9 and ICD-10 codes in a side-by-side table, select the Click to view both ICD-9 and ICD-10 link that appears just below the ICD-10 button. Both ICD-9 and ICD-10 codes will display in a user-friendly table. See the example below for Medical Policy #08.00.99a: Belimumab (Benlysta®).

For more information on the IBC transition to ICD-10, including our ICD-10 Spotlight: Know the codes and Putting ICD-10 into Practice: Coding exercises and scenarios booklets, visit the ICD-10 section of our website at www.ibx.com/icd10.

April 2013 | Partners in Health UpdateSM 9 www.ibx.com/providersApril 2013 | Partners in Health UpdateSM 9 www.ibx.com/providers

Putting ICD-10 into Practice: Coding exercises and scenarios

continued on the next page

In preparation for the transition to ICD-10, each month this section will feature an article to help you put the new guidelines and conventions you learned about last year into practice. If needed, use the ICD-10 Spotlight: Know the codes booklet for assistance with these exercises. An answer key is provided below so you can verify if your answers are correct. In addition, a list of code narratives is included on the next page to describe each ICD-10 code.

Coding exercises Code the following conditions according to ICD-10 coding conventions and guidelines:

1. Atrial tachycardia

2. Irregular astigmatism of both eyes

3. Shaken infant syndrome, initial encounter

4. Painful respiration

5. Neonatal esophageal reflux

6. Twin pregnancy, one placenta, two amniotic sacs, third trimester with complication of gestational hypertension

7. Lisping

8. Subacute monocytic leukemia, in remission

9. Neoplasm of uncertain behavior of the nasal cavities

10. Benign carcinoid tumor of the small intestine

11. Atypical chest pain due to angina

Coding scenarioCode the following scenario according to ICD-10 coding conventions and guidelines:

Due to ailing health, Jane’s grandfather will be moving in with her in a few months. To understand what care is needed, Jane escorted her grandfather to his doctor appointment for the first time. The doctor told Jane that her grandfather was being treated for mild nonproliferative diabetic retinopathy with macular edema. He has type 2 diabetes and takes insulin on a daily basis. He has also developed diabetic cataract in his right eye.

Answers to coding exercises:

1) I47.1 2) H52.213 3) T74.4xxA 4) R07.1 5) P78.83 6) O30.033, O13.3 7) F80.0 8) C93.91 9) D38.5 10) D3A.019 11) R07.89, I20.9

Answer to coding scenario:

E11.321, E11.36, Z79.4

April 2013 | Partners in Health UpdateSM 10 www.ibx.com/providersApril 2013 | Partners in Health UpdateSM 10 www.ibx.com/providers

Putting ICD-10 into Practice: Coding exercises and scenarios (continued)

NarrativesThe following are the corresponding code narratives for each of the ICD-10 codes in the answer key for the coding exercises and coding scenario:

ICD-10 code Code narrative

I47.1 Supraventricular tachycardia

H52.213 Irregular astigmatism, bilateral

T74.4xxA Shaken infant syndrome, initial encounter

R07.1 Chest pain on breathing

P78.83 Newborn esophageal reflux

O30.033 Twin pregnancy, monochorionic/diamniotic, third trimester

O13.3 Gestational (pregnancy-induced) hypertension without significant proteinuria, third trimester

F80.0 Phonological disorder

C93.91 Monocytic leukemia, unspecified in remission

D38.5 Neoplasm of uncertain behavior of other respiratory organs

D3A.019 Benign carcinoid tumor of the small intestine, unspecified portion

R07.89 Other chest pain

I20.9 Angina pectoris, unspecified

E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema

E11.36 Type 2 diabetes mellitus with diabetic cataract

Z79.4 Long term (current) use of insulin

For additional information related to the IBC transition to ICD-10, please visit www.ibx.com/icd10. On this site you will find examples of how ICD-9 codes will translate to ICD-10 codes in the ICD-10 Spotlight: Know the codes booklet. In addition, you will find examples of ICD-10 coding exercises and scenarios in the Putting ICD-10 into Practice: Coding exercises and scenarios booklet.

April 2013 | Partners in Health UpdateSM 11 www.ibx.com/providers

navineT®

A new transaction — called Population Management Tools — will be available later this month through the NaviNet web portal and allows IBC-participating primary care physicians in the Pennsylvania five-county service area access to the new Comparative Procedure Costs tool.

This tool provides network cost ranges and provider-specific relative cost rankings for a menu of treatment categories. These rankings, which are displayed at the facility level, are based on the historical total cost of each encounter based on the contracted facility and professional costs.

Using the Comparative Procedure Costs toolTo get started, select Population Management Tools from the Plan Transactions menu. You will then be prompted to select your office from a drop-down menu. When finished, click Submit.

Available this month: The Comparative Procedure Costs tool

continued on the next page

April 2013 | Partners in Health UpdateSM 12 www.ibx.com/providers

navineT®

Available this month: The Comparative Procedure Costs tool (continued)

In order to access the Comparative Procedure Costs tool, you must first read and agree to the Terms and Conditions. This page also contains a link to the methodology used to determine the cost rankings that are displayed, as well as links to quality information you can use when making care decisions for IBC members.

Once you have read and agreed to the Terms and Conditions, select the Comparative Procedures Costs Tool link to enter the tool.

Select your search criteria by choosing from the various drop-down menus. Once complete, select the Get results button.

continued on the next page

April 2013 | Partners in Health UpdateSM 13 www.ibx.com/providers

Available this month: The Comparative Procedure Costs tool (continued)

The results will display all of the facilities that have a ranking for the criteria selected, as well as a typical cost range for the selected treatment category. Use the arrows at the bottom of the page to scroll through all of the results or to change your display options.

Results are automatically sorted by the Comparative Cost Ranking of either $, $$, or $$$. You have the ability to sort by provider name or the distance from the ZIP code. There is also an option to create a PDF of your search results that you can either save or print for future reference. You can change your search criteria at any point and select Get results to refresh the page and display the new search results. Future enhancements to this tool will include additional treatment categories.

If you have questions regarding this new tool, please call the eBusiness Provider Hotline at 215-640-7410. Your office location was required to register for NaviNet by April 1, 2013. If you have not done so, please visit www.navinet.net and select Sign Up from the top right.

Note: Cost data is refreshed twice a year.

navineT®

April 2013 | Partners in Health UpdateSM 14 www.ibx.com/providers

navineT®

NaviNet registration requirement now in effect

Reminder: NaviNet Claim INFO Adjustment requirement

As previously communicated, access to the NaviNet web portal is now a requirement for all providers (including any third-party agencies that assist with administrative/billing activities).

Several self-service requirements are already in effect, such as obtaining claim status information and member eligibility and submitting certain authorization types, and new initiatives have been announced that will require the sole use of NaviNet in order to interact with IBC. We will continue to introduce a series of new requirements requiring the use of NaviNet in the near future.

If you have not already registered for NaviNet, please do so by going to www.navinet.net and selecting Sign Up from the top right. If you have questions regarding the registration process or the NaviNet requirement in general, please call the eBusiness Provider Hotline at 215-640-7410.

As previously communicated, in 2011 we introduced our provider self-service initiative, which requires providers to use our automated tools for member eligibility and claim status inquiries. We are now expanding the provider self-service requirements to include questioning of claim payments or to request a claim adjustment. This requirement is already in place for primary care physicians who participate in the Quality Incentive Payment System (QIPS) program and will apply to all participating providers, including those contracted with Magellan Behavioral Health, Inc. for PPO business.

Effective May 1, 2013, providers who call Customer Service to question claim payments or to request a claim adjustment will be directed to submit the request via the NaviNet web portal. NaviNet offers the Claim INFO Adjustment transactions to ensure that your claim adjustment requests are addressed in the most efficient manner available.

Using the Claim INFO Adjustment Submission transaction The Claim INFO Adjustment Submission transaction allows ancillary, facility, and professional providers to submit adjustment requests or question claim payments for paid or denied claims for a period of up to 18 months after adjudication of the original claim or as required by applicable law. Each submission is assigned a unique adjustment identification (ID) number.

You can access IBC’s response within ten business days through the Claim INFO Adjustment Inquiry transaction. If you do not receive a response within ten business days of the submission, please call Customer Service and have your adjustment ID number available.

To access the Claim INFO Adjustment Submission transaction, select Claim Inquiry and Maintenance from the Plan Transactions menu. Detailed user guides for these transactions are available on our Plan Central page under Administrative Tools & Resources.

Your office location was required to register for NaviNet by April 1, 2013. If you have not done so, please visit www.navinet.net and select Sign Up from the top right. If your office is currently NaviNet-enabled, but would like training on how to submit a claim adjustment or retrieve a response to a submitted request through NaviNet, please contact our eBusiness Provider Hotline at 215-640-7410.

Magellan Behavioral Health, Inc., an independent company, manages mental health and substance abuse benefits for most IBC members.

Help Medicare-eligible patients prevent diabetes with SilverSneakers®

As you know, chronic diseases exact a particularly heavy health and economic burden on older adults due to associated long-term illness, diminished quality of life, and increased health care costs. In 2005, 133 million people—almost half of all Americans—lived with at least one chronic condition and 70 percent of all deaths in this country were attributed to chronic diseases. The medical care costs of people with chronic diseases account for more than 75 percent of the nation’s $2 trillion medical care costs.1

Diabetes is one of the fastest growing conditions in the United States. The risk of developing type 2 diabetes is highly correlated with lifestyle factors, specifically poor diet and physical inactivity. According to the American Diabetes Association, type 2 diabetes can be prevented through modest lifestyle changes and losing about 5 to 7 percent of body weight. Being active can help to control and maintain body weight and stabilize blood sugar levels and blood pressure. Exercise can also help prevent heart and blood flow problems, reducing the risk of heart disease and nerve damage, which are often problems for people with diabetes.

The Centers for Disease Control and Prevention (CDC) recommend moderate-intensity physical activity, such as brisk walking, swimming, or bicycling, for 2.5 hours every week and muscle-strengthening activities on two or more days a week.2 Patients who are not accustomed to physical activity should start slowly and work their way up. Talk to your patients about a safe exercise plan.

SilverSneakers can helpResearch shows Medicare-eligible patients with diabetes who participate in the Healthways SilverSneakers Fitness Program are admitted to the hospital less often, have lower inpatient care costs, and see significant reductions in their overall health care costs after only a year.3 SilverSneakers is the nation’s leading exercise program for Medicare-eligible patients, offering physical activity, health education, and social events. SilverSneakers members receive a complimentary membership with access to a variety of participating locations throughout the country.

Note: SilverSneakers is offered to Keystone 65 HMO and Personal Choice 65SM PPO members at no cost. To enroll in the program, members should bring their SilverSneakers ID card to a participating SilverSneakers location. Members can visit the SilverSneakers website at www.silversneakers.com or call 1-888-423-4632 for a complete list of locations.

1 www.healthcare.gov/news/factsheets/2011/05/grants05132011a.html2 www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html3 http://care.diabetesjournals.org/content/31/8/1562.full

SilverSneakers is a program of Healthways, Inc., an independent company.

April 2013 | Partners in Health UpdateSM 15 www.ibx.com/providers

HealtH and Wellness

I m p o r t a n t r e s o u r c e s

Visit our website: www.ibx.com/pnc

* Outside 215 area code

Anti-Fraud and Corporate Compliance Hotline 1-866-282-2707

www.ibx.com/antifraud

Care Management and Coordination Case Management 1-800-313-8628

Baby BluePrints® 215-241-21981-800-598-BABY (2229)*

ConnectionsSM Health Management Programs ConnectionsSM Health Management Program Provider Support Line 1-866-866-4694

ConnectionsSM Complex Care Management Program 1-800-313-8628

ConnectionsSM Provider Portal www.hdproviderportal.com/ibc

Credentialing Credentialing Violation Hotline

215-988-1413www.ibx.com/credentials

Customer Service/Provider Services Provider Automated System (eligibility/claims status/referrals) Connections Health Management Programs Precertification/maternity requests — Imaging services (CT, MRI/MRA, PET, and nuclear cardiology) — Authorizations

1-800-ASK-BLUE(275-2583)

Provider Services user guide www.ibx.com/providerautomatedsystem

eBusiness Help Desk 215-241-2305

FutureScripts® (pharmacy benefits) Prescription drug prior authorization Fax

1-888-678-70121-888-671-5285

Direct Ship Specialty Pharmacy Program Fax

1-888-678-70121-888-671-5285

Mail order program toll-free fax 1-877-228-6162

Blood Glucose Meter Hotline 1-888-678-7012

Pharmacy website (formulary updates, prior authorization) www.ibx.com/rx

FutureScripts® Secure (Medicare Part D) 1-888-678-7015

Formulary updates www.ibxmedicare.com

Mail order program toll-free fax 1-877-344-1318

IBC Direct Ship Injectables Program (medical benefits) www.ibx.com/directship

Medical Policy www.ibx.com/medpolicy

NaviNet® portal registration www.navinet.net

Provider Supply Line 1-800-858-4728

www.ibx.com/providersupplyline