An Independent Licensee of the Blue Cross and Blue Shield Association

1. Alabama Hospital Association Meeting March 18, 2019 An Independent Licensee of the Blue Cross and Blue Shield Association

2. Enhanced Ambulatory Patient Grouping Version 3.13 Transition • EAPG transition from version 3.10 to version 3.13, effective 4/1/2019 • EAPG 3.13 Base Rates: Letters of Agreement due March 31, 2019 • EAPG 3.13 National Weight file: Available on ProviderAccess

4. Outpatient Precertification Requirements • Precertification required for Provider-Administered Drug Program in outpatient hospital setting • Effective for dates of service April 1, 2019, and after • If authorization is not obtained, the facility’s claim may not process appropriately

5. Preferred Radiology Transition to AIM • Precertification required for the following: • Positron emission tomography (PET) scans; Computerized axial tomography (CT); Computed tomographic angiography (CTA) tests; Magnetic resonance imaging (MRI); Magnetic resonance angiography (MRA) • Precertification is not required for tests ordered during an emergency room treatment visit while in the observation unit or during an inpatient stay • The list of procedure codes that will require precertification via AIM is available on ProviderAccess.

6. Preferred Medical Labs

7. Out of Network Providers • Participating hospitals must ensure hospital-based physicians are in-network. • Services provided by out-of-network providers may result in higher member out of pocket costs.

8. Short Term Limited Duration Plan • Single and family coverage • 6-month or 364-day product available for members • No benefits for pre-existing conditions • Verify benefits to determine eligibility

9. Eligibility Verification • As of January 1, 2019, Quantum handles customer service, precertification and medical review for Blue Cross and Blue Shield of Alabama group. • Verify eligibility and benefits prior to rendering services.

10. New Medical and Drug Policies Site

11. Durable Medical Equipment Complaints • Members are receiving DME that has not been requested. • Educate patients prior to discharge to be aware of phone calls asking if they need DME and accepting equipment not discussed during discharge

12. Provider Solutions Mailbox

13. Thank You