1. Alabama Hospital Association Meeting
March 18, 2019
An Independent Licensee of the Blue Cross and Blue Shield Association

2. Enhanced Ambulatory Patient Grouping Version
3.13 Transition
EAPG transition from version 3.10 to version 3.13, effective 4/1/2019
EAPG 3.13 Base Rates: Letters of Agreement due March 31, 2019
EAPG 3.13 National Weight file: Available
on ProviderAccess

3. New EAPG Timely Topics webcast available on ProviderAccess
EAPG 3.13 Definitions Manual: Available to all EAPG contracted facilities
Contact: Denise Hansen, 3M Customer Acct Management Representative
New EAPG Timely Topics webcast available on ProviderAccess
Upcoming EAPG Version 3.13 Webinar – Coming Soon

4. Outpatient Precertification Requirements
Precertification required for Provider-Administered Drug Program in outpatient hospital setting
Effective for dates of service April 1, 2019,
and after
If authorization is not obtained, the facility’s claim may not process appropriately

5. Preferred Radiology Transition to AIM
Precertification required for the following:
Positron emission tomography (PET) scans; Computerized axial tomography (CT); Computed tomographic angiography (CTA) tests; Magnetic resonance imaging (MRI); Magnetic resonance angiography (MRA)
Precertification is not required for tests ordered during an emergency room treatment visit while in the observation unit or during an inpatient stay
The list of procedure codes that will require precertification via AIM is available on ProviderAccess.

6. Preferred Medical Labs
Effective April, 1, 2019, non-patient reference labs must be billed on a 1500 claim.
Non-PML facilities must sign the PML contract prior to April 1, 2019.
to request a contract.
Reimbursement is based on the PML fee schedule.

7. Out of Network Providers
Participating hospitals must ensure hospital-based physicians are in-network.
Services provided by out-of-network providers may result in higher member out of pocket costs.

8. Short Term Limited Duration Plan
Single and family coverage
6-month or 364-day product available
for members
No benefits for pre-existing conditions
Verify benefits to determine eligibility

9. Eligibility Verification
As of January 1, 2019, Quantum handles customer service, precertification and medical review for Blue Cross and Blue Shield of Alabama group.
Verify eligibility and benefits prior to
rendering services.

10. New Medical and Drug Policies Site

11. Durable Medical Equipment Complaints
Members are receiving DME that has not
been requested.
Educate patients prior to discharge to be aware of phone calls asking if they need DME and accepting equipment not discussed during discharge

12. Provider Solutions Mailbox
Customer Service is first point of contact for assistance
Provider Solutions assists with escalation issues.
When sending inquiries to Provider Solutions, ensure inquiry is sent to only one mailbox to prevent duplicate cases.
Hospital escalated claim inquiries should be sent to

13. Thank You