Requirements Information for BQPP Application 1-04-11 · Requirements Information for the Blue Quality Physician Programsm Application Proprietary and Confidential 2 participate in

Requirements Information for the Blue Quality Physician Programsm Application Proprietary and Confidential

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Criteria Definition NCQA Physician Practice Connections® – Patient- Centered Medical HomeTM (PPC®- PCMHTM)

PPC-PCMH is appropriate for all primary care medical practices including: Family Practice, Internal Medicine, General Practice, and Pediatrics. Please Note: OBGYN practices should seek the Physician Practice Connection (PPC) Recognition not the Patient Centered Medical Home Recognition. All locations must be PPC or PPC- PCMH recognized. A Recognition Program developed by the National Committee for Quality Assurance (NCQA) with input of the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and American Osteopathic Association (AOA) and designed to recognize practices that use systematic, patient-centered, coordinated care management processes. The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Among the aspects of care measured by PPC-PCMH are: Access and Communication, Patient Tracking and Registry Functions, Care Management, Patient Self-Management Support, Electronic Prescribing, Test Tracking, Referral Tracking, Performance Reporting and Improvement and Advanced Electronic Communications.

Please refer to the NCQA website www.ncqa.org for more information. NCQA offers a 20% discount to practices that are sponsored when they apply to receive their NCQA Recognitions. Blue Cross Blue Shield of North Carolina is considered your sponsor. Check the NCQA website and fee schedule for discounts and information regarding changing levels within a program or converting from PPC to PCMH.

There are three levels of NCQA PPC-PCMH Recognition (Basic, Intermediate, and Advanced). To


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participate in the Blue Quality Physician Program your practice (if multiple sites, all sites) must be recognized in PPC or PPC-PCMH. The Program awards points to practices that are recognized in PPC-PCMH based on their level of recognition. Achieving and maintaining recognition in the PPC-PCMH OR PPC Recognition Program is a mandatory requirement for participation in the Blue Quality Physician Program. Validation Source: NCQA Website

NCQA Physician Practice Connection® (PPC®)

PPC is appropriate for all primary care and specialties practices including OBGYN. All locations must be PPC or PPC-PCMH recognized. A Recognition Program developed by the National Committee for Quality Assurance (NCQA) designed to recognize practices that use systematic processes and information technology to enhance the quality of patient care. Meeting PPC® standards shows practices have established connections to information, patients and other providers that allow them to:

• Know and use patient histories • Follow up with patients and other providers • Manage patient populations and use evidence –based care • Employ electronic tools to prevent medical errors.

Among the aspects of care measured by PPC are: Access and Communication, Patient Tracking and Registry Functions, Care Management, Patient Self-Management Support, Electronic Prescribing, Test Tracking, Referral Tracking, Performance Reporting and Improvement, and Interoperability.

Please refer to the NCQA website www.ncqa.org for more information. NCQA offers a 20% discount to practices that are sponsored when they apply to receive their NCQA Recognitions. Blue Cross Blue Shield of North Carolina is considered your sponsor. Check the NCQA website and fee schedule for discounts and information regarding changing levels within a program or converting from PPC to


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PCMH.

There are three levels of NCQA PPC Recognition (Basic, Intermediate, and Advanced). To participate in the Blue Quality Physician Program your practice (if multiple sites, all sites) must be recognized in PPC or PPC-PCMH. The Program awards points to practices that are recognized in PPC based on their level of recognition.

Achieving and maintaining recognition in the PPC-PCMH OR PPC Recognition Program is a mandatory requirement for participation in the Blue Quality Physician Program.

Validation Source: NCQA Website

NCQA Diabetes Recognition Program (DRP or DPRP)

A Recognition Program developed by the National Committee for Quality Assurance (NCQA) in partnership with the American Diabetes Association (ADA) designed to recognize physicians who use evidence-based measures and provide excellent care to their patients with diabetes. This program was formerly known as the Diabetes Physician Recognition Program (DPRP).

The DRP Program has 10 measures which cover areas such as:

� HbA1c control � Blood Pressure control � LDL control � Eye examinations � Nephropathy assessment � Smoking status and cessation advice or treatment

Please refer to the NCQA website www.ncqa.org for more information. NCQA offers a 20% discount to practices that are sponsored when they apply to receive their NCQA Recognitions. Blue Cross Blue Shield of North Carolina is considered your sponsor.

The Blue Quality Physician Program will award points for successful completion of one of the following


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diabetes programs: • NCQA Diabetes Physician Recognition Program (DRP or DPRP) • Diabetes Practice Improvement Module (PIM) from the American Board of Internal Medicine

(ABIM) • Diabetes Performance in Practice Module (PPM) from the American Board of Family Medicine

(ABFM)

Validation Source: NCQA Website, data file from ABIM, or Attestation from physician that ABFM Diabetes PPM is completed.

NCQA Heart/Stroke Recognition Program (HSRP)

A Recognition Program developed by the National Committee for Quality Assurance (NCQA) in partnership with the American Heart Association (AHA/ASA) designed to recognize physicians who use evidence-based measures and provide excellent care to persons with cardiovascular disease (CVD) or who have had a stroke.

The HSRP assesses key quality performance measures for secondary prevention of cardiovascular disease and stroke. Program measures include:

� Blood pressure control � Complete lipid profile � Cholesterol control � Use of aspirin or another antithrombotic � Smoking status and cessation advice or treatment


The Blue Quality Physician Program will award points for successful completion of one of the following cardiac programs:


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• NCQA Heart/Stroke Recognition Program (HSRP) • Preventive Cardiology Practice Improvement Module (PIM) from the American Board of Internal

Medicine (ABIM) • Hypertension Practice Improvement Module (PIM) from the American Board of Internal

Medicine (ABIM) • Hypertension Performance in Practice Module (PPM) from the American Board of Family

Medicine (ABFM) • Heart Failure Performance in Practice Module (PPM) from the American Board of Family

Medicine (ABFM) • Coronary Artery Disease Performance in Practice Module (PPM) from the American Board of

Family Medicine (ABFM) Validation Source: NCQA Website, data file from ABIM, or Attestation from physician that ABFM Cardiac PPM is completed.

NCQA Back Pain Recognition Program (BPRP)

A Recognition Program developed by the National Committee for Quality Assurance (NCQA) designed to recognize physicians and chiropractors who deliver superior care to patients who suffer from low back pain. The BPRP program consists of 13 clinical measures and three structural standards such as the elements of the physical exam and advice for the return to normal activities. These requirements address the broad spectrum of low back pain and focus on under use, misuse and overuse of treatment modalities.


The Blue Quality Physician Program awards points to providers that are recognized in BPRP.


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Validation Source: NCQA Website

Diabetes Practice Improvement Module (PIM) from the American Board of Internal Medicine (ABIM)

The American Board of Internal Medicine (ABIM) Diabetes Practice Improvement Module (PIMSM) is a self-evaluation tool designed to give the physician a snapshot of his/her practice. It shows how outcomes and processes of care for their patients compare with national guidelines for managing diabetes. A PIM is a Web-based tool that enables physicians to conduct a confidential self-evaluation of the medical care that they provide. PIMs help physicians gain knowledge about their practices through analysis of data from the practice, and the development and implementation of a plan to target areas for improvement. PIMs are part of ABIM’s Maintenance of Certification program, within the Self-Evaluation of Practice Performance requirement. Please refer to http://www.abim.org/online/pim/demo.aspx for more information. The Blue Quality Physician Program will award points for successful completion of one of the following diabetes programs:

• NCQA Diabetes Physician Recognition Program (DRP or DPRP) • Diabetes Practice Improvement Module (PIM) from the American Board of Internal Medicine


(ABFM) Validation Source: NCQA Website, data file from ABIM, Attestation from physician that ABFM Diabetes PPM is completed.

Cardiology Practice Improvement Modules (PIM) from the American Board of Internal Medicine (ABIM)

The American Board of Internal Medicine (ABIM) offers Cardiology Practice Improvement Modules (PIMSM ). A PIM is a Web-based tool that enables physicians to conduct a confidential self-evaluation of the medical care that they provide. PIMs help physicians gain knowledge about their practices through analysis of data from the practice, and the development and implementation of a plan to target areas for improvement. PIMs are part of the ABIM Maintenance of Certification program, within the Self-


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Evaluation of Practice Performance requirement. The ABIM Preventive Cardiology PIM is a self-evaluation tool designed to give the provider a snapshot of his/her practice buy showing them how the outcomes and processes of care for their patients compare with national guidelines for preventing primary and secondary coronary heart disease (CHD). The ABIM Hypertension PIM is a self-evaluation tool designed to give the provider a snapshot of his/her practice by showing them how the outcomes and processes of care for their patients compare with national guidelines for managing hypertension. Please refer to http://www.abim.org/online/pim/demo.aspx for more information. The Blue Quality Physician Program will award points for successful completion of one of the following cardiac programs:






Family Medicine (ABFM) Validation Source: NCQA Website, data file from ABIM, Attestation from physician that ABFM Cardiac PPM is completed.

Diabetes Performance in The American Board of Family Medicine (ABFM) offers Performance in Practice Modules (PPM) as


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Practice Module (PPM) from the American Board of Family Medicine (ABFM)

part of the Part IV Maintenance of Certification. These modules are web-based, quality improvement modules in health areas which generally correspond to the Self-Assessment Modules.

Each physician will assess his or her care of patients using evidence-based quality indicators. After a physician enters data from ten patients into the ABFM website, feedback is provided for each of these quality indicators. The performance data is used by the physician to choose an indicator for which a quality improvement plan will be designed. Using a menu of interventions available from various online sources, the physician designs a plan of improvement, submits the plan, and implements the plan in practice. After a minimum of three months, the physician assesses the care provided to ten patients in the chosen health area and inputs the data to the ABFM website. The physician then is able to compare pre- and post-intervention performance, and compare their results to those of their peers.

Please refer to https://www.theabfm.org/moc/part4.aspx for more information.

The Blue Quality Physician Program will award points for successful completion of one of the following diabetes programs:

• NCQA Diabetes Physician Recognition Program (DRP or DPRP) • Diabetes Practice Improvement Module (PIM) from the American Board of Internal Medicine


(ABFM) Validation Source: NCQA Website, data file from ABIM, Attestation from physician that ABFM Diabetes PPM is completed.

Cardiac Performance in Practice Module (PPM) from the American Board of Family Medicine (ABFM)

The American Board of Family Medicine (ABFM) offers Performance in Practice Modules (PPM) as part of the Part IV Maintenance of Certification. These modules are web-based, quality improvement modules in health areas which generally correspond to the Self-Assessment Modules.

Each physician will assess his or her care of patients using evidence-based quality indicators. After a


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physician enters data from ten patients into the ABFM website, feedback is provided for each of these quality indicators. The performance data is used by the physician to choose an indicator for which a quality improvement plan will be designed. Using a menu of interventions available from various online sources, the physician designs a plan of improvement, submits the plan, and implements the plan in practice. After a minimum of three months, the physician assesses the care provided to ten patients in the chosen health area and inputs the data to the ABFM website. The physician then is able to compare pre- and post-intervention performance, and compare their results to those of their peers.

The ABFM offers 3 Cardiac Performance in Practice Modules. They are:

• Hypertension • Heart Failure • Coronary Artery Disease

Please refer to https://www.theabfm.org/moc/part4.aspx for more information.

The Blue Quality Physician Program will award point for successful completion of one of the following cardiac programs:






Family Medicine (ABFM)


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Validation Source: NCQA Website, data file from ABIM, Attestation from physician that ABFM Cardiac PPM is completed.

Asthma Education in Quality Improvement for Pediatric Practice (eQIPP) from the American Academy of Pediatrics (AAP)

The goal of the American Academy of Pediatrics (AAP) Education in Quality Improvement for Pediatric Practice (eQIPP) course entitled Diagnosing and Managing Asthma in Pediatrics is designed to help physicians create a plan for improvement to address gaps that are identified in key clinical activities of asthma care. Activities include:

• Collect and analyze baseline data to establish a starting point for improvement • Identify one or more quality gaps in one or more key clinical activities of asthma care • Create an improvement plan for closing the quality gap(s) in which you:

o Identify a specific aim; o Establish a target goal; o Generate ideas for change; and o Consider potential barriers.

• Implement change(s) designed to close the quality gap(s). • Collect and analyze follow-up data to measure the results of your improvement efforts • Create additional improvement plans and repeat the change-improvement cycle until you reach

your goal of providing the best possible asthma care to patients.

Please refer to http://www.eqipp.org for more information.

The Blue Quality Physician Program will award points to Physicians that have successfully completed the Asthma eQIPP. Validation Source: Physician Certificate indicating successful completion of eQIPP course.

Immunizations Education in Quality Improvement for Pediatric Practice

The American Academy of Pediatrics (AAP) Education in Quality Improvement for Pediatric Practice (eQIPP) course entitled Give Your Immunization Rates A Shot In the Arm is designed to identify immunization rates in the practice, barriers to immunization delivery systems and techniques to


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(eQIPP) From the American Academy of Pediatrics (AAP)

overcome those barriers through the use of clear aims that reflect expert principles and proven quality improvement methods and tools. Objectives of the Immunization eQIPP include:

• Apply recommended storage and handling guidelines for vaccines. • Identify payment and coding issues as potential barriers to best immunization practices. • Improve payment and coding issues related to improving immunization rates.

The Blue Quality Physician Program will award points to Physicians that have successfully completed the Immunization eQIPP. Validation Source: Physician Certificate indicating successful completion of eQIPP course.

Improving Performance in Practice (IPIP) from the NC Healthcare Quality Alliance and NC AHEC

IMPROVING PERFORMANCE IN PRACTICE (IPIP) is a national initiative with practice-based improvements at its core which is delivered via state- and local-level agencies as part of the North Carolina Healthcare Quality Alliance. In North Carolina, the regional AHEC offers IPIP at no charge to practices. IPIP participants must provide direct or consultative care to patients with asthma or diabetes. The IPIP initiatives use clinical data from the practice EHR to guide improvement in patient care; an important component of EHR “meaningful use.”

Please refer to http://www.ahecqualitysource.com for more information.

The Blue Quality Physician Program will award points to Physicians who actively participate in IPIP for at least 12 months to receive ABP MOC, Part IV credit. Validation Source: BCBSNC receives a spreadsheet from NC AHEC of the practices/physicians that completed at least 12 months of the IPIP to earn credit toward MOC, Part IV.

OBGYN Office Practice Modules from the

The American Board of Obstetrics and Gynecology (ABOG) and the American College of Obstetrics and Gynecology (ACOG) have created a joint program for Part IV, Continuous Quality Improvement


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American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG)

(Practice Performance and Self-Assessment), of the Maintenance of Certification (MOC) program. The Road to Maintaining Excellence program is designed to help ACOG members and diplomates remain current and knowledgeable with best practice recommendations. The Road to Maintaining Excellence program consists of reviewing “modules” on current recommended or best practices along with a “self-assessment” of one’s practice to ascertain if current recommendations have been adopted. This latter aspect of Part IV is accomplished via a chart review of diagnoses or conditions covered in a specific module. The American Board of Obstetrics and Gynecology (ABOG) and the American College of Obstetrics and Gynecology (ACOG) offer the following three modules on OBGYN Office Practice in their Maintenance of Certification (MOC) Part IV Modules:

• Management of Atypical Cells of Uncertain Significance (ASCUS) • Ambulatory Treatment of Pelvic Inflammatory Disease (PID) • Osteoporosis

Please refer to https://moc.acog.org for more information. The Blue Quality Physician Program will award points to physicians that have successfully completed all three OBGYN Office Practice modules. Validation Source: ACOG MOC Data

Diseases in Pregnancy Modules from the American College of Obstetrics and Gynecology (ACOG) and the American Board of

The American Board of Obstetrics and Gynecology (ABOG) and the American College of Obstetrics and Gynecology (ACOG) have created a joint program for Part IV, Continuous Quality Improvement (Practice Performance and Self-Assessment), of the Maintenance of Certification (MOC) program. The Road to Maintaining Excellence program is designed to help ACOG members and diplomates remain current and knowledgeable with best practice recommendations.


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Obstetrics and Gynecology (ABOG)

The Road to Maintaining Excellence program consists of reviewing “modules” on current recommended or best practices along with a “self-assessment” of one’s practice to ascertain if current recommendations have been adopted. This latter aspect of Part IV is accomplished via a chart review of diagnoses or conditions covered in a specific module. The American Board of Obstetrics and Gynecology (ABOG) and the American College of Obstetrics and Gynecology (ACOG) offer the following three modules on Diseases in Pregnancy in their Maintenance of Certification (MOC) Part IV Modules:

• Chronic Hypertension in Pregnancy • Gestational Diabetes (GDM) • Preeclampsia

Please refer to https://moc.acog.org for more information. The Blue Quality Physician Program will award points to physicians that have successfully completed all three Diseases in Pregnancy modules. Validation Source: ACOG MOC Data

OBGYN Patient Safety Modules from the American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG)

The American Board of Obstetrics and Gynecology (ABOG) and the American College of Obstetrics and Gynecology (ACOG) have created a joint program for Part IV, Continuous Quality Improvement (Practice Performance and Self-Assessment), of the Maintenance of Certification (MOC) program. The Road to Maintaining Excellence program is designed to help ACOG members and diplomates remain current and knowledgeable with best practice recommendations. The Road to Maintaining Excellence program consists of reviewing “modules” on current recommended or best practices along with a “self-assessment” of one’s practice to ascertain if current recommendations have been adopted. This latter aspect of Part IV is accomplished via a chart review of diagnoses or conditions covered in a specific module.


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The American Board of Obstetrics and Gynecology (ABOG) and the American College of Obstetrics and Gynecology (ACOG) offer the following three modules on Patient Safety in their Maintenance of Certification (MOC) Part IV Modules:

• Safe Use of Medications • Informed Consent • Informed Refusal

Please refer to https://moc.acog.org for more information. The Blue Quality Physician Program will award points to physicians that have successfully completed all three modules in one of the following Patient Safety programs:

• Patient Safety Modules from the American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG) Maintenance of Certification (MOC) Part IV Modules

• Patient Safety Improvement Program from the American Board of Medical Specialties (ABMS)

Validation Source: ACOG MOC Data or Physician Attestation that they have completed the ABMS Patient Safety Improvement Program.

Patient Safety Improvement Program from the American Board of Medical Specialties (ABMS)

The American Board of Medical Specialties (ABMS) Patient Safety Improvement Program combines online patient safety education, quality improvement education and performance improvement activities that focus on identifying and analyzing errors, determining improvements based on best practices and implementing changes. Results are measured and benchmarked against national standards.

This Web-based program is self-paced and focuses on identifying and analyzing errors, determining improvements based on best practices and implementing changes. The program aligns with key initiatives, including The Joint Commission National Patient Safety Goals, and Institute for Healthcare


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Improvement 5 Million Lives Campaign.

The ABMS Patient Safety Improvement Program consists of the following four key components:

1. Scenarios that illustrate common errors and the complex systems involved, 2. Patient safety curriculum in four broad categories, 3. Quality improvement fundamentals to apply methods and techniques to clinical environments and 4. Patient safety improvement activities that introduce changes that can be incorporated into

practice.

The Patient Safety Improvement Program from the ABMS is comprises of three (3) modules. They are:

• Core Curriculum Sections including Epidemiology, Systems, Communication, and Safety Culture • Quality Improvement Fundamentals • Performance Improvement Activities

Please refer to http://www.abms.org/Products_and_Publications/Performance_Improvement/PSIP.aspx for additional information.

The Blue Quality Physician Program will award points to physicians that have successfully completed all three modules in one of the following Patient Safety Programs:

• Patient Safety Modules from the American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG) Maintenance of Certification (MOC) Part IV Modules

• Patient Safety Improvement Program from the American Board of Medical Specialties (ABMS) Validation Source: ACOG MOC Data or Physician Attestation that they have completed the ABMS Patient Safety Improvement Program.

BCBSNC Medical Record BCBSNC Quality Management Consultants conduct periodic assessments to monitor and evaluate the


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Review Score quality and appropriateness of physicians' documentation in office medical records. The purpose is to ensure that the medical record keeping practices conform to the Plan's medical record standards and meet the targets specified in the Quality Improvement Work Plan. Practices are reviewed every three years and given a Medical Record Review Score. The Blue Quality Physician Program will take into consideration the most recent Medical Record Review Score. Points will be awarded to practices that achieve a score of 95% or above on their Medical Record Review. If the practice or group has several sites, the average Medical Records Review Score of all sites must be 95% or above in order to earn points. Validation Source: BCBSNC Internal Data

Electronic Prescribing Electronic Prescribing refers to the use of a secure computer network so that providers, pharmacies, pharmacy benefit managers and health plans can share patient prescription information. As a decision-support tool, Electronic Prescribing lets providers access an individual patient’s medication history, see the particulars of the patient’s prescription insurance coverage, and review details about the medication of choice – all in order to make more informed choices about patient care. Physicians interested in Electronic Prescribing must use either a standalone Electronic Prescribing software or an Electronic Medical Record (EMR) that has been certified to connect to the Surescripts network. Only prescriptions sent over the Surescripts network will be tracked for this program.

The Blue Quality Physician Program will award points for use of an electronic prescribing standalone software or EMR that has been certified to connect to the Surescript network.

Usage of Electronic Prescribing is a mandatory requirement for participation in the Blue Quality Physician Program.

Validation Source: Data feed from Surescripts


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Electronic Health Record An Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter, as well as supporting other care-related activities directly or indirectly via interface—including evidence-based decision support, quality management, and outcomes reporting.( http://www.himss.org ) To meet this element, the practice must use an electronic health record certified by the Certification Commission for Health Information Technology (CCHIT). See http://www.cchit.org/

The Blue Quality Physician Program will award points for use of an Electronic Health Record as described above. However, practices that achieve an Advanced level in PPC®- PCMHTM or PPC® will not receive additional points for utilizing an Electronic Health Record because use of the EHR is included in the criteria for those NCQA programs.

Validation Source: BCBSNC Internal Data and/or Attestation from the practice that they use an HER that is in compliance with the above criteria.

Claims submitted electronically

Claims submitted by providers electronically constitute the percentage of claims that BCBSNC receives from a provider in an electronic format (non-paper) as a function of their total claims submissions. Methods for electronic submission include direct submission from the provider using ANSI X12 batch 837 transactions, use of a vendor or clearinghouse for ANSI X12 submission, RealMed realtime claims submission, or direct data entry (keying the claim) through Blue e. The Blue Quality Physician Program will award points for electronic claims submission based on the percentage of claims that the practice submits electronically. Electronic submission of claims is a mandatory requirement for participation in the Blue Quality Physician Program.


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Validation Source: BCBSNC Internal Data

Utilization of Blue e Transactions

Usage of the BCBSNC electronic provider portal, Blue e has multiple uses. For example, a provider may make an electronic inquiry through Blue e to obtain information on patient eligibility, claim status, and remittance information. Blue e is also used to capture educational or operational updates from the What’s New application. The provider’s purpose for using Blue e is to receive detailed information in an accurate and timely manner thereby reducing the amount of time spent on the phone and in the generation of correspondence by the provider’s office. The four Blue e service modules that contribute the Blue Quality Physician Program score from the include the following:

• What's New – The Blue e application that gives the provider community important updates about BCBSNC. It includes information on upcoming changes, billing questions and general information.

• Eligibility – This transaction displays general benefit and eligibility information (copays,

deductibles, etc) for BCBSNC, Blue Card, FEP and the State Health Plan. Eligibility information is available for a rolling 36 months.

• Claim status – This transaction provides information to a provider on the processing system status

of a claim (paid, processed, denied, etc.) It includes payment amounts as well as patient liability if the status in the system is paid.

• Self Administration –The capability of a provider to be able to add/delete Blue e users as well as

reset passwords without having to contact BCBSNC for assistance in performing these functions. The Blue Quality Physician Program will award points for use of the Blue e transaction modules.


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Validation Source: BCBSNC Internal Data

Use of Council for Affordable Quality Healthcare (CAQH) for credentialing

The Council for Affordable Quality Healthcare (CAQH) maintains a Universal Provider Datasource (UPD) to be used for providing credentialing information to health plans. The Blue Quality Physician Program awards points to practices that have active credentialing applications for their providers on the UPD. For more information go to www.caqh.org The Blue Quality Physician Program will award points for use of CAQH for credentialing. Validation Source: Universal Provider Datasource from CAQH

Accept EOP and NOP only in electronic format

BCBSNC makes electronic copies of paper remits available to providers through the secure web portal Blue e. Providers who allow BCBSNC to suppress the print of paper Explanation of Payment (EOP)/Notification of Payment (NOP) (remit) information save themselves and the plan money through automation of documents that otherwise would be printed and mailed to providers. The Blue Quality Physician Program will award points to practices for accepting remit data via electronic means only, meaning no paper remits are mailed. Validation Source: BCBSNC Internal Data

After Hours Care Regularly scheduled weekday office hours between 5:00 pm and 8:00 am, in addition to 35 hours of regularly scheduled weekday hours. The Blue Quality Physician Program awards points to practices that have 7 or more regularly scheduled office hours after 5:00 pm and before 8:00 am in addition to 35 hours of regularly scheduled weekday hours. Validation Source: Practice Website and/or confirmatory phone call to the practice


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Weekend Office Hours Regularly scheduled office hours on Saturdays and/or Sundays

The Blue Quality Physician Program awards points to practices that have 7 or more regularly scheduled weekend office hours in addition to 35 hours of regularly scheduled weekday hours. Validation Source: Practice Website and/or confirmatory phone call to the practice

Cultural Competency Training

Complete interactive training focused on cultural competency in medical practice, (such as provided by the US Department of Health and Human Services [DHHS] or Quality Interactions). The purpose of this training is to help enhance skills toward the provision of care in a culturally competent clinical practice. Culturally competent care includes providing patient-centered care, tailoring delivery to meet patients' social, cultural, and linguistic needs; identifying and applying appropriate strategies to reduce racial and ethnic healthcare disparities; understanding the impact that stereotyping can have on medical decision making; and identifying techniques to deal with language barriers and other communication needs, including working with interpreters. More information on the US DHHS Office of Minority Health Cultural Competency Training can be obtained at https://www.thinkculturalhealth.hhs.gov/ Quality Interactions is an innovative e-learning program that provides effective cultural competency and cross-cultural communication training. For more information please visit http://www.qualityinteractions.org/ Quality Interaction will offer a 50% off the cost of the program to BQPP BCBSNC providers, To sign up visit: http://www.qualityinteractions.org/index.new.html

Promo Code at checkout: nc_diversity

The Blue Quality Physician Program awards points to practices that have completed one of the


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following Cultural Competency Training programs:

1. Quality Interactions training, 2.5 hour course��2. US DHHS (completion of 2 themes), 6 hour course��3. Quality Interactions training, 6 hour course�4. US DHHS (completion of 3 themes), 9 hour course��

Option 1 or 2 = 10 points towards the BQPP score Option 3 or 4 = 15 points towards the BQPP score Completion of one of the above Cultural Competency training courses is a mandatory requirement for the Blue Quality Physician Program. Validation Source: Provider must submit copy of certificate received from one of the above Cultural Competency training courses.

E Visits E-Visits refer to a Practice’s ability to interact with patients through a secured electronic channel in place of a formal office visit. Patients can contact their provider through a Web-based interface, or “Portal,” which includes an online questionnaire that the patient must complete. Practices can use one of several external (not associated with BCBSNC) vendor companies for their Portal service. Data collected can include symptoms, pharmacy, and payment information. E-Visits are typically used to address non-urgent, ongoing, or new symptoms. Practices must sign an attestation that they are in compliance with BCBSNC Corporate Medical Policy E-Visits (online medical evaluation) MED1141. The attestation form can be found at http://wwwdev.bcbsnc.com/content/providers/index.htm The Blue Quality Physician Program awards points to practices that have a signed Provider E Visit Attestation on file at BCBSNC Network Management Department.


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Validation Source: Confirmation of BCBSNC receipt of Provider’s E Visit Attestation.

Precepting medical students

Bonus points are available to physicians who have precepted at least 3 medical students within the past year. Physicians must complete the attestation form for the precepting of medical students which is available on the opening page of the BQPP website. This completed attestation form should be submitted at the same time as the BQPP application is submitted.

Credentialing In order to be eligible for the enhanced fee schedule for BQPP, all mid-level providers in the practice must be credentialed and enrolled with BCBSNC.

This chart indicates individual physician recognition and educational options based on the physician specialty.

Family Practice Internal Medicine General Practice OBGYN Pediatrics NCQA Diabetes Recognition Program (DPRP) or (DRP) OR Diabetes PPM from ABFM

NCQA Diabetes Recognition Program (DPRP) or (DRP) OR Diabetes PIM from ABIM

NCQA Diabetes Recognition Program (DPRP) or (DRP)

ACOG MOC Part 4 Modules for OBGYN Office Practice which include all of the following: • Management of

Atypical Cells of Uncertain Significance (ASCUS)

• Ambulatory

Asthma eQIPP from AAP


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Treatment of Pelvic Inflammatory Disease (PID)

• Osteoporosis NCQA Heart Stroke Recognition Program (HSRP) OR Coronary Artery Disease PPM from ABFM OR Hypertension PPM from ABFM OR Heart Failure PPM from ABFM

NCQA Heart Stroke Recognition Program (HSRP) OR Preventive Cardiology PIM from ABIM OR Hypertension PIM from ABIM

NCQA Heart Stroke Recognition Program (HSRP)

ACOG MOC Part 4 Modules for Diseases in Pregnancy which include all of the following: • Chronic

Hypertension in Pregnancy

• Gestational Diabetes (GDM)

• Preeclampsia




Either the ACOG or ABMS Patient Safety Modules 1. ACOG MOC Part 4

Patient Safety Modules which include all of the following: • Safe Use of

Medications • Informed

Consent • Informed Refusal

OR

Immunizations eQIPP from AAP


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2. ABMS Patient Safety Modules which include: • Core Curriculum

Sections (Epidemiology, Systems, Communication, Safety Culture)

• Quality Improvement Fundamentals

• Performance Improvement Activities

IPIP MOC Part 4 Certification

• Asthma • Diabetes









Documents

Requirements Information for BQPP Application 1-04-11 · Requirements Information for the Blue Quality Physician Programsm Application Proprietary and Confidential 2 participate in