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Blue Cross of Northeastern Pennsylvania (BCNEPA) Offers Blue Health Solutions to Help Support Your Care of Our MembersYour patients with BlueCare® coverage now have access to a unique, state-of-the-art program that helps them better manage and take control of their health: Blue Health Solutions. Blue Health Solutions is different from traditional utilization management programs that solely focus on the 20% of health care users who account for 80% of health care costs. Instead, Blue Health Solutions uses advanced predictive modeling to identify members who may be at high risk, and helps them before they become high cost. This ‘proactive’ versus ‘reactive’ approach is the key to better health for patients, and for controlling rising health care premiums. BCNEPA offers resources that help patients take action and accountability for their health and supports the care that you provide for the healthiest outcomes. Blue Health Solutions program features include: MyHealth Manager , a series of disease management and care management programs that are confidential and available to eligible members at no additional cost. Programs available to support your care to our members includes: asthma, chronic obstructive pulmonary disease, coronary artery disease, diabetes, depression, heart failure, prenatal care, tobacco cessation, weight management and care management programs for catastrophic cases and for transition of care and intermediate care. You can call 1-866-262-4764, weekdays, 8 a.m. to 8 p.m. for more information and encourage your patients with BlueCare® coverage to call if it would benefit them. Once enrolled, a member will receive the following program benefits:
Each program is staffed with registered nurses specializing in that area of care, who are available weekdays, 8:00 a.m. – 5:00 p.m. Who Is Eligible to Enroll in a MyHealth Manager ProgramAll groups and direct pay members except:
All BCNEPA employees are eligible regardless of coverage or non-coverage. Criteria for Referring a Member to a MyHealth Manager ProgramAsthma
CAD ICD-9 Codes:
Procedure Codes:
Two or more outpatient, face-to-face physician visits with any of the ICD-9 codes listed above. COPD
Depression ICD-9 codes:
Diabetes ICD-9 codes:
Heart Failure
Prenatal Program
This is not a postpartum program. Weight Management Program
Click on the following links for useful Weight Management Program Criteria Charts for adult and children for use in your office. Obesity Codes used: 278.00 and 278.01 Lifestyle Management Program
Catastrophic Case Management Program
Intermediate Case Management Program
Transition of Care Program
Referring One of Your Patients to a MyHealth Manager ProgramIf you have a patient with BlueCare health care coverage who would benefit from any of our MyHealth Manager programs, we encourage you to refer them to the appropriate program or contact us directly to enroll them. To refer eligible patients, call toll free at 1-866-262-4764.* Bethann Hoffman, extension 2014 , for Prenatal, Asthma, COPD, and Tobacco Cessation programs and for Depression, CAD, Heart Failure and Diabetes programs, call Samara Mitkowski at 1-866-262-4764, extension 2033 . You can also complete a Referral Form to any MyHealth Manager Program and fax it to the Health Management Department at 200-8010. To refer a patient with BlueCare health care coverage who would benefit from one of our Case Management Programs--catastrophic, intermediate care or transition of care-- call 1-800-346-6149 or refer the patient to call, weekdays, 8 a.m. to 8 p.m. *If you choose to call to refer your patient, please be prepared to provide the information listed on the Referral Form above. Additional Resources Offered through Blue Health Solutions MyHealth Solution is an exciting online resource that helps members better manage their health through a comprehensive health assessment, personal health records file, interactive fitness and nutrition tools, customized learning tools and quizzes, symptom tracker, and more. MyHealth Coach provides a 24-hour/seven-day-a-week coaching service that helps our members make informed decisions about their health. Members can speak with a registered nurse, dietitian or respiratory therapist on a variety of health topics from chronic conditions to common health issues. Health Coaches can inform members so they know what questions to ask their physicians at their next visit. MyHealth Mart offers members discounts on numerous health and health-related services and products such as fitness classes, nutritional services, massage therapy, yoga, laughter therapy, books, DVDs, and much more. Members are encouraged to take advantage of discounts on products and services that can help them achieve an improved level of well-being for mind and body. For a listing of participating vendors, members should call the customer service number on the back of their ID card. If your patients who are BlueCare members would like more information about any of these programs, refer them to the number on the back of their identification card or the specific number listed for each program. Practitioner Rights for DM ProgramsPractitioners have the right to:
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