BlueLink Vol.1, Issue 4 September 1999


Administrative Issues
New Pharmacy Benefit Manager for the National Capital Region
Addition to Ambulatory Surgery Center Networks
Professional Provider Training Seminars

What's Happening
Hospitalist Program Assists Members
Y2K Readiness Alert
CareFirst Options: New Complementary and Integrative Therapy Program
New Provider Office Signs

Billing and Claims Procedures
New Technology Evaluated

New Pharmacy Benefit Manager for the National Capital Region

As part of our effort to streamline administrative functions, CareFirst is consolidating its pharmacy services under a single pharmacy benefit manager. On October 1, 1999, the prescription benefit administrator for the National Capital region will change from Merck-Medco Managed Care (PAID Prescriptions) to AdvancePCS (formerly Advance Paradigm), Inc. (API).

API, a leading national administrator of prescription drug benefit programs, has served CareFirst's Maryland region members since 1996. With a network of over 50,000 retail pharmacies and a mail service pharmacy, it is well equipped to administer a total prescription benefit program for our entire service area.

Please note that this is an administrative change only and does not affect members' benefits, copayments, or deductibles. All clinical prior authorizations that are currently on file with Merck-Medco will be transferred to API. For authorizations after September 30, please call 800-294-5979. 

As a result of this change, members who use prescription mail order service may need to complete a new order form and send it with a new prescription to API. When writing prescriptions for patients who use the mail order service, please specify the exact quantity of tablets that you wish (e.g., if your patient is eligible for a 102-day supply and must take one tablet a day, please write the exact quantity of 102 and three refills; if two daily, prescribe 204, etc.)

This change does not affect the Federal Employee Program (FEP) which will continue to use Merck-Medco for mail order services and PCS for its retail pharmacy program.

Members affected by this transition will receive new prescription ID cards and detailed information by October 1, 1999. If you have any questions about this change, please contact the Provider Services Department.

Addition to Ambulatory Surgery Center Networks

We are pleased to announce that the following ambulatory surgery center recently joined the CapitalCare, Participating and Selected Preferred Provider networks:

The Center for Ambulatory Surgery
5759 Cedar Lane
Columbia, Maryland 21044
(410) 884-4500

For a complete listing of the ambulatory surgery centers in our networks, please consult your provider directories or visit our Web site at: 

Professional Provider Training Seminars


Our professional provider training seminar offers a great opportunity to learn more about CareFirst's programs, policies, and procedures. This seminar is designed for professional office staff who use the HCFA 1500 form and covers a wide range of topics, including claims filing, benefits, the Quality Improvement Program, electronic billing and HMO reimbursement programs. Please plan to attend this worthwhile class.

The next available seminars are:

All Providers:
Wednesday, September 22, 1999
10:00 a.m. - 1:00 p.m.
Greater Southeast Community Hospital
1310 Southern Avenue, S.E.
Washington, DC 20032
Parking Fee

CapitalCare Providers Only:
Wednesday, September 29, 1999
10:00 a.m. - 1:00 p.m.
CareFirst BlueCross BlueShield
550 12th Street, S.W.
Large Marketing Theater
Washington, DC 20065
Also, mark your calendars for these upcoming seminars:

CapitalCare Providers Only
October 19, 1999
INOVA Fairfax Hospital

All Providers
November 19, 1999
Location: Doctors Community Hospital

Since seating is limited, please call (202) 479-8102 to make a reservation. Reservations will be accepted up to three business days before the seminar.

 Attention: CapitalCare PCPs and office staff: 
A representative from your office must attend one of our monthly provider training seminars before October 1999 to receive credit during the next PCP Recognition Program evaluation.

Hospitalist Program Assists Members

CareFirst now offers a hospitalist program in the National Capital region through an agreement with MDxL, a company that specializes in emergency inpatient care. MDxL provides hospitalist services to members in the National Capital region who are admitted to the hospital through the emergency room. Currently, our program is offered at four suburban Maryland hospitals -- Prince George's Hospital, Shady Grove Adventist Hospital, Washington Adventist Hospital and Holy Cross Hospital.

As you may know, in a hospitalist program, when a patient is admitted to a hospital, the primary care doctor or admitting specialist extends oversight of that patient to a hospitalist. A hospitalist is a licensed physician who specializes in inpatient care. MDxL utilizes specialists from our networks to administer our hospitalist program.

Among the hospitalist's tasks are: coordinating the patient's tests and specialty care; communicating with the patient's primary care physician and insurance providers; and planning the patient's discharge, home care, hospice or assisted living.

Our program is voluntary; therefore, primary care physicians may still oversee their patients care during a hospitalization.

CareFirst believes this type of program can be a valuable enhancement to inpatient care and an excellent opportunity to offer personalized and timely care for hospital patients. This program also offers advantages for participating providers. Hospitalist coverage can help limit the pressures of hospital rounds and late-night visits to the emergency room, allowing the physician more time to spend with their patients in the office.

If you have any questions about this new program, please call the Provider Services Department at the number found in the box below.

Y2K Readiness Alert

With the new millenium approaching, it is important to remember that the year 2000 issue is not just about computers. The Y2K bug has the potential to affect anything with a date-sensitive chip, including medical equipment.

In preparing for the year 2000, please evaluate all equipment that could affect the health of your patients and their ability to receive care. Examples include: respirator pumps; diagnostic equipment (laboratory and radiology); MRI, CT scans; infusion pumps; intravenous drips; heart defibrillators; pacemaker and intensive care monitors; and dialysis, chemotherapy and radiation equipment. Besides medical equipment, various office systems could be affected. Examples include: telecommunications equipment (such as telephones, pagers, cellular phones, switchboards, fax machines, and answering services); fire and burglar alarm systems; and HVAC, lighting controls, and emergency generators.

Please work with your medical supply companies and other contracted vendors to ensure that equipment with embedded computer chips will continue to be functional into the year 2000.

CareFirst Options: New Complementary and Integrative Therapy Program

In recent years, certain unconventional therapies, such as acupuncture and chiropractic care, have grown in popularity. In addition, there is evidence that many of these techniques are effective, especially when used in conjunction with traditional medical care. At CareFirst, we support the use of unconventional therapies, not as an alternative, but as a complement to traditional medical services.

Accordingly, CareFirst is introducing CareFirst Options, the region's first complementary and integrative therapy network and discount program beginning January 1, 2000. We have partnered with OneBody, a leader in the field of credentialed complementary and integrative medicine programs, to offer CareFirst members discounts from 15% to 25% on certain alternative treatments and therapies, such as acupuncture, chiropractic care, massage therapy, and fitness center memberships. Members will not need a physician referral to take advantage of these discounts. Of course, we will encourage members to inform their doctors whenever they use these services, and we are sure that you will want to stay informed about any complementary therapies your patients may receive.

Keep in mind that CareFirst Options is a discount program and not a part of a member's CareFirst benefits. There are no claim forms, and CareFirst does not reimburse members or practitioners.

OneBody will begin to develop the CareFirst Options provider network in our service area in the fall. To participate in the program, practitioners must follow OneBody's rigorous credentialing process, which carefully evaluates training, licensure and experience. OneBody will also perform all provider credentialing and quality review, and handle inquiries from our members.

For additional information about our new discount program, please call OneBody toll-free at 888-922-9452.

New Technology Evaluated

CareFirst BlueCross BlueShield's Technology Assessment Unit evaluates new and existing technologies for application to our indemnity and managed care benefit plans. The unit relies on current medical literature, local expert consultants, and physicians to determine our position on new technologies and whether those technologies meet our criteria for coverage. The Technology Assessment Unit recently made the following determinations:



New Provider Office Signs


CareFirst recently mailed new office signs and decals bearing our new name and logo to our participating providers. We hope that you received yours. Please display the new sign in a prominent place to help your patients know that their CareFirst insurance plan is accepted by your office.

Additional signs and decals are available upon request. Please call the Provider Networks Management Department at (202) 479-8102 to place an order. To avoid confusion, please discard any outdated Blue Cross and Blue Shield signs that your office may have.

If you have questions regarding the information in this newsletter, please call the appropriate telephone number listed below:

Professional Providers (202) 479-6560
Out-of-Area Providers (800) 842-5975
Hospital and Institutional Providers (202) 646-1270

You can access information for providers through our Web site located at If you have a suggestion or comment about the Web site, please fill out the e-mail form located on the home page.