July 12, 2012

 
 
 
 

BC-12-11
 
 

To:

All Blue Cross Contracting Hospitals

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Changes coming to the BCBSKS Precertification System with the 2012 InterQual® upgrade on July 16, 2012.

On June 26, 2012 BCBSKS sent out a newsletter (BC-12-9) notifying our contracting hospitals of the upgrade of our internal electronic precertification system with the 2012 InterQual® version. This precertification system change will go into effect on July 16, 2012.  In order to assist our providers in preparing for this implementation this newsletter provides some (not all inclusive) information on the InterQual changes. A revised Precertification Manual has been published on our website (www.bcbsks.com) and is attached to this newsletter, as well as other helpful documents that can be found on our website.  Please review and become familiar with the new layout of the InterQual screens.

As noted in our June newsletter, with the release of InterQual 2012, all Acute Criteria will now utilize a “condition-specific” approach.  It organizes the criteria by primary condition and then incorporates additional information designed to address applicable complications, co-morbidities and standard treatments. This condition-oriented model presents criteria for all levels of care into one workflow.  The new version combines severity and intensity criteria for admission and continued stay review, and incorporates unique “response to treatment” evaluations.

In addition to incorporating a condition-specific approach, InterQual 2012 includes the following enhancements:

Some points to remember when loading electronic precerts:

Please use one of the contact numbers listed below to assist with your secure access or precertification questions.

BlueAccess and General Inpatient Precertification and InterQual Information Connie Winkley - Communication/Education Coordinator 1-785-291-7236
Coding for Inpatient Precertifications Cindy Garrison – BCBSKS Provider Representative for hospitals in Northern Kansas 1-785-291-8862
Coding for Inpatient Precertifications Denny Hartman – BCBSKS Provider Representative for hospitals in Southern KS 1-316-269-1602
Clinical Questions about InterQual and Medical Criteria BCBSKS Precertification Department 1-800-782-4437
Problems with BCBSKS Secure Access (BlueAccess) BCBSKS Help Desk 1-800-472-6481

Please share this information with any other members of your provider staff that will be affected by this upcoming change to the electronic BCBSKS precertification system. Encourage your staff to sign-up with our eNews to receive future updates regarding precertification that will include valuable information and instructions on the use of InterQual 2012.

Precertification Manual

Medical Review Precertification/ Pre-Authorization

Completing the Precertification for Discharged Patients

 

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