What's Inside: Offering clarity on machine-readable files and Transparency in Coverage | Important pharmacy coverage updates available | Disabled Dependent process enhancement | New health and wellness demos and programs available for your clients
Offering clarity on machine-readable files and Transparency in Coverage
After complying with the Transparency in Coverage rule about machine-readable filesby the July 1 deadline, we have received questions about the files, namely around their formatting and accessibility, and wanted to provide some background to help you better understand what they are.
Machine-readable files are digital representations of data or information that can be imported or read into a computer system for further processing. The files are formatted to help researchers and developers access and analyze data. They are not meant to be consumer-friendly resources the general public can use to search rates or compare the costs of services from one provider to another. Without a specialized system or software that can read the data, the information may be difficult to access, understand, and compare.
The Transparency in Coverage Rule also requires health plans and insurers to provide an online tool that help members with cost-share estimates for covered services and items. This requirement, which will roll out in two phases, isn’t effective until 2023. We’ll share more information about how Capital Blue Cross will comply with this requirement later. In the meantime, our members can continue to use MyCare Finder to get cost estimates on many healthcare services.
Important pharmacy coverage updates available
We updated our commercial drug formulary and utilization management program with changes that took effect on July 1. They include:
An expanded list of drugs requiring prior authorization.
Modified and new quantity level limits for specific drugs.
Drugs that have changed tier status or have been added to the specialty program.
Details on the changes, as well as a full listing of our formulary and specifics on our pharmacy utilization management programs, are available on our website.
Disabled Dependent process enhancement
The Patient Protection and Affordable Care Act mandates health insurance issuers that offer coverage to both adults and their dependents must allow dependents to remain on their parents' or guardians’ plan until the dependents are 26 years old; however, once a dependent reaches 26 years old, he or she may remain on the plan if he or she meets certain disability requirements.
As of June 29, 2022, we have started to identify new dependents (age 25 or older) listed on an enrollment file for large (100+) ASO groups. The account executive will reach out to respective groups, giving the group the option of adding a dependent to the group coverage as a disabled dependent prior to receiving the completed disability paperwork from the subscriber.
This enhanced process will allow the group to decide whether to add the dependent upon the effective date to ensure no lapse in coverage, while the subscriber completes the disability paperwork. If the group selects this option, the group is confirming eligibility for the disabled dependent and will be responsible for all claims incurred on/after the effective date.
New health and wellness demos and programs available for your clients
The Capital Blue Cross Health Promotion and Wellness team is pleased to announce new virtual cooking demonstration themes and recipes that will inspire members to prepare meals at home. Preparing meals at home gives everyone in the family an opportunity to build better eating habits, one meal at a time.
Themes include: carb-conscious, plant-powered, healthy twists, on-the-go, family and budget friendly, healthy lunches, heart-healthy, and holidays.
If you want to learn more or are interested in sharing this great opportunity with your clients, reach out to your dedicated Senior Health Education Consultant or email CBC.HeatlhInformation@capbluecross.com to schedule.
Your producer relations team
Capital Blue Cross has adopted a team approach to support you, as we collaborate to enhance business relationships, foster your growth through education and incentives, and actively support the communities we serve. The Producer Relations team thanks you for your commitment and hard work. Reach out whenever you need them.