Blue Cross Newsletter

December 6, 2010


To: All Blue Cross Contracting Providers

Cindy Garrison, CPC – Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association


National Consumer Cost Tool

The Blue Cross and Blue Shield Association (BCBSA) believes that engaging and empowering consumers to make more knowledgeable health care decisions is a fundamental priority. In the rapidly changing healthcare environment, consumers need information that can help them take an active role in managing care for themselves and for their families. Consumer engagement requires not only offering the right information to make informed health decisions through improved transparency capabilities, but also simplifying how consumers get to the information and related decision support tools through better navigation of the health care system.

The BCBSA has developed a National Consumer Cost Tool (NCCT) capability to be implemented January 1, 2011.  The purpose is to enable members to obtain information on estimated costs for common health care services.  The consumer-facing cost tool is designed to provide the data transparency essential to engaging consumers in their healthcare decision making.

The NCCT will not be available to Blue Cross and Blue Shield of Kansas members at this time.  However, other Blue Plans will have this information available to their members and thus their members could view Kansas provider information.

Member's access will be through the member’s Blue online customer service Web site.  The member will enter their member Identification number, select the treatment category, and select the geographic area desired for service.  Members can choose from fifty-four of the most common, elective procedures for inpatient, outpatient and diagnostic services.  The Blue Distinction Center designations will display as appropriate to any specific facility for a relevant procedure.   Also, average cost estimates for five types of Office Visit are available without provider-specific designation.

The estimates are developed using twelve months of claims data from contracting facilities. Medicare and secondary claims are excluded.  For the inpatient treatment, categories episodes are built by summing all claims created at the facility from admission to discharge. Outpatient episodes sum all claims created on that day of service at that facility and also may include ‘pre-work’ diagnostics done beforehand. The diagnostic episodes isolate just the claims specific to that procedure. A set of exclusions are used to filter out outliers and episodes with complications.  As appropriate, refinements are applied to the historical claims to present the reasonable ranges based on current arrangements. Market ranges or ‘cost bands’ based on a fixed percentage of the market average are then assigned to a facility for each treatment category.  Cost estimates are updated approximately every six months.

The information presented to the member will contain, the approximate costs for the selected treatment category, for hospital/facility-based services, the approximate costs with the name and practice location of the hospital/facility, the approximate out of pocket liability calculated by the member’s Plan, and links to supplemental information such as health/wellness, care management, quality, etc.

For any questions you have about the NCCT, please contact your provider consultant.

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