Blue Cross Blue Shield

The Blue Cross and Blue Shield Association is the national trade organization that associates 38 independent regional health insurance companies in the United States and Canada. It was formed in the 1982 fusion of the Blue Cross Association and the National Association of Blue Shield Plans that are founded basically in Chicago, Illinois. Both organizations trace their histories to health plans that were created around the same time in two different parts of the U.S. The progression of managed health care in the United States is closely linked to the designs of Blue Cross-Blue Shield.

Blue Cross and Blue Shield Plans are presenting Medicare Advantage and Medicare Prescription Drug Plans in local markets across the country. Blue Cross and Blue Cross of California are being scrutinized by California regulators after 10 lawsuits were filed against Blue Cross in March 2006 claiming that the company had not acted in a good loyalty to thwart fraud and it also had a special department specifically set up to methodically look for any justification to reject coverage for large claims.

When the company issues a medical insurance policy, the person insured thinks he or she has medical coverage and relies on it and the person can find out other coverage if the company has a legitimate reason for denying coverage and tells the person at the time of the insurance application. If the insurance company doesn’t review applications until claims are filed and then retroactively cancels the policies, the people insured by the company find themselves without insurance and prone for all the medical expenses they thought were covered by their medical insurance. This is a very serious injury caused by the insurance company’s bad faith failure to assess the application in a timely manner.

Blue Cross offers the Healthy Families Programme in all 58 California counties, as a Health Management Organization (HMO) product in 11 counties and as an Exclusive Provider Organization (EPO) product in the remainder of counties. Blue Cross of California is the largest health coverage provider with more than 125.000 members, nearly 40 percent of the total programme membership and it has approximately 323.000 children contributing in the Healthy Families Programme statewide.

Blue Cross of California, with 5.4 million medical members, is the California operating auxiliary of Well Point Health Networks Inc. Well Point serves the health care needs of more than 7.6 million medical and approximately 34 million specialty members nationally. Well Point offers a broad spectrum of quality network-based health products including open access PPO, POS and hybrid products, and HMO and specialty products. Specialty products include dental, vision, mental health, life and disability insurance, long term care insurance, pharmacy benefit management, utilization management, flexible spending accounts, COBRA administration, and Medicare supplements.

Tamilselvi is a SEO copywriter for forhealthplans.com. She has written many articles in various topics. For more information visit http://www.forhealthplans.com She can be reached at tamil@searchenginegenie.com

Cigna Replaces Blue Cross Blue Shield At The Top Of Chiropractic Billing Precision Index In March

Billing Performance Index (BPI) in March 2007 underperformed its February value by another 1.3%, dropping the index from 17.6 down to 18.9, while replacing three of BPI participants in February on the list of top ten performers. Chiropractic Billing Performance Index guides chiropractic office managers and helps the development of both chiropractic billing software and billing performance standards. This article describes the 10-th iteration of a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.

BPI = 18.9 means that the average of ten top performing payers working with Billing Precision clients have 18.9% of Accounts Receivable beyond 120 days. BPI is a key billing performance characteristic, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index as recorded in the Billing Precision's system.

 

• Billing Precision Index 18.9
• Cigna 12.9 (down from 12.4 in February)
• Blue Cross Blue Shield Illinois 15.1 (down from 11.2 in February)
• Blue Cross Blue Shield Texas 15.2 (down from 14.3 in February)
• Blue Cross Blue Shield Pennsylvania 17.7
• Medicare New Jersey 20.5 (down from 17.6 in February)
• Aetna 20.9 (down from 17 in February)
• Blue Cross Blue Shield Alabama 21.3
• Medicare Pennsylvania 23.1
• United Healthcare 23.2 (down from 19.7 in February)
• Blue Cross Blue Shield New Jersey 24.3 (down from 20.5 in February)

 

March BPI dropped three participants since February:

• Blue Cross Blue Shield South Carolina
• Medicare Illinois
• Medicare Wisconsin

 

Improved index since February: None.

Seven participants lowered their indexes with respect to February BPI:

• Cigna 12.9 (down from 12.4 in February)
• Blue Cross Blue Shield Illinois 15.1 (down from 11.2 in February)
• Blue Cross Blue Shield Texas 15.2 (down from 14.3 in February)
• Medicare New Jersey 20.5 (down from 17.6 in February)
• Aetna 20.9 (down from 17 in February)
• United Healthcare 23.2 (down from 19.7 in February)
• Blue Cross Blue Shield New Jersey 24.3 (down from 20.5 in February)

 

March BPI added three new participants since February:

• Blue Cross Blue Shield Pennsylvania 17.7
• Blue Cross Blue Shield Alabama 21.3
• Medicare Pennsylvania 23.1

 

Coverage

BPI is rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

BillingPrecision.com updates BPI on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accommodate future growth of provided information, index combinations, and sensitivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Chiropractic Billing Performance Index helps the development of both chiropractic billing software and billing performance standards. Chiropractic office managers can use the index to benchmark their billing performance and guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics.

Yuval Lirov, PhD, author of "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial intelligence and Computer Security, and CEO of Vericle.net Billing Technologies and Services. Vericle® unites hundreds of billing services across the nation. Its electronic medical billing software tracks payer performance from a single point of control and shares compliance rules globally. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.