THE BLUES
RULE BUILDING
COST SHARE
SYSTEMS
MISCELLANEOUS
100

THIS MICROSOFT APPLICATION ALLOWS THE USER TO ORGANIZE CONTENT ACROSS NOTEBOOKS, SECTIONS AND PAGES.

WHAT IS ONENOTE?  

100

WHEN FAST TRACKING COST SHARE OR CREATING A NEW ACCUMULATOR OR NAMED LIST, THIS TYPE OF REQUEST MUST BE SENT FOR APPROVAL.


WHAT IS A GBL-ENT REQUEST?

100

IF A NEW GLOBAL COST SHARE MAXIMUM IS NOT DEFINED IN A CERTIFICATE OR LOWER TRUMPING DOCUMENT, THIS MUST BE UPDATED, OR A CONFLICT MAY OCCUR DURING TRANSLATION.

WHAT IS THE DISPLAY NAME?

100

WHEN DOING A KEYWORD SEARCH IN THIS WEB-BASED PLATFORM, ALL DOCUMENTS THAT INCLUDE THE KEYWORD SHOULD BE REFERENCED FOR INFORMATION.


WHAT IS SHAREPOINT?

100

WHEN AN ASC PLAN MOD INCLUDES COVERAGE FOR BOTH REGULAR AND MEDICARE MEMBERS. THE REGULAR ASC PLAN MOD SHOULD BE COMPLETED FIRST AND THIS FEATURE SHOULD BE USED TO COMPLETE THE MEDICARE ASC PLAN MOD.

WHAT IS THE COPY DOC FEATURE?

200

EVERY YEAR, UAW-BCBSM JOINT PROGRAMS AND LIFESECURE PARTNERS WITH THIS ORGANIZATION IN THEIR EFFORTS TO FEED HUNGRY CHILDRED THROUGH PROGRAMS LIKE FREE SCHOOL BREAKFAST.

WHAT IS THE UNITED WAY?

200

IF AN EXISTING DIAGNOSIS NAMED LIST IS BEING EDITED UPDATES ARE REQUIRED FOR THE VERSIONS THAT INCLUDE OR DATE BACK TO THIS DATE.

WHAT IS 01/01/2018?

200

WHEN A COPAY IS BEING REMOVED IN ITS ENTIRETY, THE COPAY SHOULD BE ADDED TO THE DOCUMENT AND THIS BOX SHOULD BE SELECTED.

 

WHAT IS REMOVE MAXIMUM?

200


WHEN A COVERAGE AGREEMENT OR BENEFIT PACKAGE ID (BPID) IS NOT AVAILABLE, A MEDICAL STRING MAY BE OBTAINED FROM THIS APPLICATION.


WHAT IS FORMS TRANSLATION MANAGER (FTM)?

200

THESE TYPES OF DOCUMENTS DO NOT TRANSLATE AND HAVE NO BPID, AS NO ACTUAL BENEFIT PACKAGE EXISTS FOR THESE GROUPS.

WHAT ARE GPV’S?

300

IN 2022, DIVERSITY MBA MAGAZINE RANKED BCBSM AS ONE OF THE BEST PLACES TO WORK FOR THESE INDIVIDUALS.

WHO ARE WOMEN AND DIVERSE MANAGERS?

300


THIS INDICATOR IN BENEFIT EDITOR IS ONLY AVAILABLE FOR A STANDALONE PRIMARY DIAGNOSIS RULE AND ALLOWS FOR MULTIPLE DIAGNOSIS CODES TO BE BILLED ON AN OUTPATIENT FACILITY CLAIM.


WHAT IS THE FACILITY HANDLING INDICATOR?

300

BEFORE REQUESTING A NEW COPAY, DETERMINE IF THE GENERAL COPAY OR THIS COST SHARE MAXIMUM CAN BE USED TO ACCOMMODATE THE COST SHARE VALUE.

WHAT IS THE SPECIALIZED COINSURANCE?

300

TO ENSURE THAT THE BENEFIT EXPLAINER QUICKVIEW TEMPLATE ACCURATELY DISPLAYS TIER BENEFITS, ALL HOSPITAL TIER DOCUMENTS MUST BE LOADED TO DOC EDITOR USING THIS DOC CATEGORY.

WHAT IS A CST RIDER 3?

300


WHEN REVIEWING THIS PCR TYPE, THE ONLY ACTION WOULD BE TO ASSIGN THE PCR TO THE APPLICABLE CODES.

 


WHAT IS D – DOCUMENTATION ONLY?


400


THIS AREA WITHIN BCBSM, MAINTAINS KEY POLICIES SUCH HAS THE HEALTH INFORMATION PRIVACY POLICY AND THE PRIVACY INCIDENT RESPONSE MANAGEMENT POLICY.


WHAT IS THE PRIVACY OFFICE?

400

WHEN A NEW ACCUMULATOR REQUIRES MANUAL CODING TO EXECUTE IN A SPECIFIC MANNER I.E. COUNT MORE THAN JUST THE EVENT FLAGS SET IN HISTORY, THIS BOX MUST BE SELECTED?

WHAT IS THE CONDITIONAL RENEWAL BOX?

400

THIS INCLUDES ALL DOLLARS FROM THE CURRENT BENEFIT YEAR PLUS THOSE FROM THE PREVIOUS YEAR’S FOURTH QUARTER UNCONDITIONALLY, MEANING WHETHER OR NOT THE MEMBER’S DEDUCTIBLE WAS MET AND DOLLARS WERE OR WERE NOT PAID.

WHAT IS MICHIGAN 4TH QUARTER CARRYOVER?

400

THIS FILE, HOUSED WITHIN NASCO PROCESSING SYSTEMS (NPS), CALCULATES BENEFIT ACCUMULATIONS AND MAXIMUM INFORMATION REAL-TIME.


WHAT IS THE BENEFIT ACCUMULATION FILE?

400

IN THESE IBU RIDERS, RX CARVEOUT RULES ARE PRESENT AND NO COST SHARE VALUES ARE ESTABLISHED AS COST SHARE IS REMOVED SYSTEMATICALLY.

WHAT ARE THE NATIVE AMERICAN LIMITED COST-SHARING RIDERS?

500

WITH THIS PROGRAM, BCBSM HAS BEEN PROFILED IN MORE THAN 30 COUNTRIES ACROSS FIVE CONTINENTS.

WHAT IS THE COLLABORATIVE QUALITY INITIATIVES PROGRAM?

 

500

THIS UNIQUE IDENTIFIER, TIED TO AN EVENT, CAN BE FOUND ON A NASCO CLAIM AND DETERMINES WHETHER OR NOT A SERVICE WAS COUNTED.

WHAT IS AN NPS FLAG NUMBER?

500

WHEN ADDING AN AGGREGATE OUT-OF-POCKET MAXIMUM, THE DISPLAY NAME SHOULD BE UPDATED TO THIS.

WHAT IS CONTRACT OUT-OF-POCKET?

500

THIS GENO TABLE IS THE FIRST ITEM REFERENCED DURING CLAIMS PROCESSING AND IDENTIFIES IF A CLAIM WILL BE PROCESSED THROUGH THE TRIPLE TIER HOSPITAL LOGIC.


WHAT IS MIHMPTAB?

500

THESE THREE PROCEDURE CODES ARE CONSIDERED BEHAVIORAL HEALTH ONLINE VISIT CODES IF BILLED BY AMWELL.

WHAT ARE PC’S 99213, 90792 AND 90834.