Current Provider Newsletter - Bluegrass Family Health
Current Provider Newsletter - Bluegrass Family Health
Current Provider Newsletter - Bluegrass Family Health
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<strong>Provider</strong> Network News<br />
Inside This Issue:<br />
BFH Partners with<br />
ConnectYourCare 2<br />
Important Payment<br />
Notification 2<br />
Mental <strong>Health</strong> and<br />
Substance Abuse 2<br />
Restrictions on<br />
Oral Ketoconazole 3<br />
PA of Newer Oral<br />
Anti-Coagulants 3<br />
Welcoming Our New<br />
Medical Director 3<br />
PS Staff Contacts 4<br />
Winter 2014<br />
Kentucky <strong>Health</strong> Benefit Exchange, <strong>Bluegrass</strong> <strong>Family</strong><br />
<strong>Health</strong>, and You.<br />
<strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> (BFH) is participating in the Small Group and<br />
Employee section of the Kentucky <strong>Health</strong> Benefit Exchange (kynect). BFH is<br />
being offered in Regions 3, 5, and 6, which includes Louisville, Lexington, and<br />
Northern Kentucky, with highest enrollment numbers in Jefferson and Fayette<br />
counties.*<br />
At this time, 100,096 Kentuckians are enrolled in new health insurance and<br />
since Thanksgiving week, the site has enrolled nearly 1,600 Kentuckians each<br />
day into new health coverage. In addition, 1,232 small businesses have started<br />
applications for employee coverage with 500 of those businesses having<br />
completed applications, making them eligible to offer coverage to employees.*<br />
As a participating provider with BFH, you are automatically included in the<br />
network. BFH will be using its standard network, contracts, and payment<br />
structures for this program.<br />
BFH kynect members will have an identification card (ID) which will contain<br />
necessary insurance information. Group numbers for the Kentucky Exchange<br />
will begin with the letters “EX.” Plan codes for the Kentucky Exchange plans will<br />
begin with the letters “KE.” For any questions, please feel free to contact your<br />
<strong>Provider</strong> Services representative.<br />
*Statistics obtained from http://governor.ky.gov/healthierky, dated December 23, 2013<br />
Lexington Office<br />
651 Perimeter Dr.<br />
Suite 300<br />
Lexington, KY 40517<br />
Nashville Office<br />
2630 Elm Hill Pike<br />
Suite 110<br />
Nashville, TN 37214<br />
Announcement of 2014 Prior Authorization List<br />
<strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> has updated its Precertification/Authorization<br />
(PA) list effective January 1, 2014. A copy of the new PA list was mailed to<br />
participating providers in November 2013. PA of medical services can be<br />
obtained by contacting BFH’s <strong>Health</strong>care Operations Department (HCO) at 1-<br />
877-449-2884 or 859-335-3737.<br />
PA of certain medications, either provider or self-administered, delivered in<br />
an outpatient setting (i.e. physician office, clinic, outpatient hospital or home<br />
setting), can be obtained by contacting BFH’s Pharmacy Department at 1-877-<br />
205-6308 or 859-335-3755.<br />
The PA list is also available on the BFH website at www.bgfh.com.<br />
RA01/14.439
<strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> Partners with ConnectYourCare for Consumer-<br />
Directed <strong>Health</strong>care Administration Solutions<br />
Since 2012, <strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> has partnered with ConnectYourCare to provide best-in-industry<br />
administrative service and tools for Consumer-Directed <strong>Health</strong>care accounts. By partnering with<br />
ConnectYourCare, an industry leader in the administration of HSAs, FSAs, HRAs, and other tax-advantage<br />
accounts, <strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> is able to offer top-tier solutions and expert support to our employer<br />
clients and account participants.<br />
<strong>Provider</strong>s also benefit from this new relationship as <strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> and ConnectYourCare<br />
equally value the ability to process claims and release payment as quickly as possible. Employees can<br />
review and pay healthcare claims quickly and conveniently from their accounts with enhanced application<br />
features. Payments may even be sent directly to the healthcare provider. <strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> believes<br />
simplifying healthcare to be vital to strengthening its relationship with members, employer groups, and<br />
network providers.<br />
Important Notification Regarding Your Claims Payments<br />
from <strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong>, Inc.<br />
<strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong>, Inc. (BFH) has teamed up with Emdeon to offer you several payment and<br />
remittance advice options.<br />
Coming soon: Instead of receiving paper check payments with your Explanations of Payment (EOP), you<br />
will begin receiving Virtual Card payments from BFH. The virtual card payment includes all the information<br />
necessary to collect the payment using your current Point of Sale (POS) terminal. This payment process is<br />
similar to manually keying in patient payments today. Be sure to enter the payment information for the full<br />
amount of the card’s value prior to the expiration date on the card. Please note: Your standard merchant<br />
fees will apply.<br />
Virtual Card payments can help you get paid faster using your existing POS terminal!<br />
No enrollment is necessary! Since funds will be deposited almost immediately from BFH into your<br />
merchant account, you get paid faster. BFH providers will automatically begin receiving Virtual<br />
Card payments on EOPs soon.<br />
The Virtual Card Payment is the newest option that BFH is making available to our provider network as<br />
a payment option. In addition to the Virtual Card Payment, BFH offers electronic funds transfers (EFT via<br />
Automated Clearing House (ACH)) and electronic remittances via (ASC X12 835 TR3).<br />
Additional information and details regarding this new payment options will be sent to you by Emdeon<br />
unless you have previously opted out of the Virtual Credit Card program through Emdeon. If you have any<br />
questions, you can visit the Emdeon ePayment Enrollment website at http://www.emdeon.com/epayment/<br />
enrollment/.<br />
Mental <strong>Health</strong> & Substance Abuse Services<br />
<strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> (BFH) uses Optum<strong>Health</strong> SM Behavioral Solutions 1 (Optum) provider network,<br />
claims, and case management services.<br />
All claims for <strong>Bluegrass</strong> members will need to be submitted to the following address and payments will<br />
be based on your agreed-upon rates with Optum:<br />
Optum<strong>Health</strong> Behavioral Solutions<br />
P O Box 30757<br />
Salt Lake City, UT 84130-0757<br />
In addition, please note that all mental health services are required to be reviewed for medical necessity.<br />
You may contact Optum at 877-369-2201, with further information available at www.ubhonline.com.<br />
1<br />
Optum<strong>Health</strong> Behavioral Solutions is a service mark of United Behavioral <strong>Health</strong>.
Restrictions on the Use of Oral Ketoconazole<br />
The FDA has placed strict limitations on the use of<br />
ketoconazole tablets. Ketoconazole is now used orally only<br />
as a last resort to treat life-threatening fungal infections<br />
for patients who cannot take other antifungal drugs or<br />
when other antifungals are not available. However, liver<br />
damage may be associated with its use – particularly when<br />
ketoconazole is taken at high doses or when it is taken by<br />
patients who have liver conditions or alcoholism. Additionally, oral ketoconazole interferes with the way<br />
that a large number of other drugs are used by the body.<br />
Taking ketoconazole together with certain drugs, such as some statins or some anti-anxiety agents,<br />
has resulted in higher than expected blood levels of the other drug. Serious, sometimes fatal, side<br />
effects have occurred, including heart problems and kidney failure. Ketoconazole also is known to block<br />
the production of steroids by the adrenal glands, a condition known as adrenal insufficiency. Untreated<br />
adrenal insufficiency may affect blood pressure, blood sugar, heart function, and weight. The FDA now<br />
requires the labels of oral ketoconazole products to have warnings about all three safety issues.<br />
A Medication Guide explaining the safety concerns is required to be given to every patient who is<br />
prescribed oral ketoconazole. Topical forms of ketoconazole do not have similar risks and they are not<br />
included in the new restrictions.<br />
More information regarding this safety update can be found on FDA’s MedWatch website at: http://www.<br />
fda.gov/Safety/MedWatch/default.htm<br />
Newer Oral Anti-Coagulants - Xarelto, Pradaxa, and Eliquis<br />
Please note: The newer oral anti-coagulants - Xarelto, Pradaxa, and Eliquis - require Prior<br />
Authorization (PA) for BFH members. Even if initiated inpatient, PA is required to continue therapy<br />
outpatient.<br />
BFH criteria requires the member to have had a documented trial and failure, intolerance, or<br />
contraindication to warfarin therapy, which may include highly variable International Normalized Ratio<br />
(INR) lab results while on warfarin therapy, pregnancy, gastrointestinal bleeding, or other generally<br />
accepted contraindications to the use of warfarin.<br />
<strong>Bluegrass</strong> <strong>Family</strong> <strong>Health</strong> Welcomes New Medical Director -<br />
Melissa V. Avery, MD, MMM, FAAFP, CPE<br />
After growing up in East Tennessee, Dr. Avery matriculated with a B.S. in Biochemistry from Rhodes<br />
College and received her medical degree from the University of Tennessee College of Medicine <strong>Health</strong><br />
Sciences Center, both in Memphis. She was trained in <strong>Family</strong> Medicine at Greenville Hospital System<br />
in Greenville, South Carolina, whereby she started her own family practice. Later, Dr. Avery worked with<br />
Medicare and Medicaid Managed Care as well as commercial insurers in all areas of operations.<br />
Dr. Avery is a Fellow of the American Academy of <strong>Family</strong> Physicians and a Diplomat of the American<br />
College of Physician Executives; she is Board Recertified by the American Board of <strong>Family</strong> Medicine<br />
and Certified by the Certifying Commission in Medical Management. Locally, she is an active member<br />
of the Lexington Medical Society. Dr. Avery lives in the Lexington, Kentucky area and has farms on the<br />
Kentucky/Tennessee border.
Visit Us Online at www.bgfh.com<br />
651 Perimeter Dr.<br />
Suite 300<br />
Lexington, KY 40517<br />
Nonprofit Organization<br />
U.S. Postage<br />
PAID<br />
PERMIT NO.119<br />
Lexington, KY<br />
Ben Singleteary<br />
Director, <strong>Provider</strong> Services<br />
Main Line: (859) 268-5367<br />
Toll free: (800) 787-2680 ext. 5367<br />
Email:<br />
ben.singleteary@bgfh.com<br />
Sue Ciaramitaro<br />
<strong>Provider</strong> Services Specialist<br />
Main Line: (615) 872-8770 ext. 2506<br />
Toll free: (866) 471-8770 ext. 2506<br />
Email:<br />
sue.ciaramitaro@bgfh.com<br />
Theresa Cloyd<br />
Hospital Services Specialist<br />
Main line: (859) 335-4112<br />
Toll free: (800) 787-2680 ext. 4112<br />
Email:<br />
theresa.cloyd@bgfh.com<br />
Kimberley Georgoulis<br />
<strong>Provider</strong> Services Specialist<br />
Main line: (859) 335-4120<br />
Toll free: (800) 787-2680 ext. 4120<br />
Email:<br />
kimg@bgfh.com<br />
<strong>Provider</strong> Services Staff<br />
Mike Strother<br />
Supervisor <strong>Provider</strong> Services<br />
Main Line: (859) 268-5349<br />
Toll Free: (800) 787-2680 ext. 5349<br />
Email:<br />
mike.strother@bgfh.com<br />
Donna Q. Johnson<br />
<strong>Provider</strong> Services Specialist<br />
Main Line: (859) 268-5376<br />
Toll Free: (800) 787-2680 ext. 5376<br />
Email:<br />
donna.johnson@bgfh.com<br />
Judith Knecht<br />
Ancillary Services Specialist<br />
Main Line: (859) 335-4122<br />
Toll Free: (800) 787-2680 ext. 4122<br />
Email:<br />
judith.knecht@bgfh.com<br />
Dee Whaley<br />
<strong>Provider</strong> Services Specialist<br />
Mainline: (859) 268-5374<br />
Toll free: (800) 787-2680 ext. 5374<br />
Email:<br />
dee.whaley@bgfh.com
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