Trigon Blue Cross Blue Shield Works to Improve Physician Relations.Business Editors/Health & Medical Writers RICHMOND Richmond, cities, United States Richmond. 1 City (1990 pop. 87,425), Contra Costa co., W Calif., on San Pablo Bay, an inlet of San Francisco Bay; inc. 1905. , Va.--(BW HealthWire)--May 18, 2001 Earlier this week the Blue Cross and Blue Shield Association
The Guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for the Role of Participating Physicians in Health Plans are a product of ongoing efforts between BCBSA and the American Medical Association American Medical Association (AMA), professional physicians' organization (founded 1847). Its goals are to protect the interests of American physicians, advance public health, and support the growth of medical science. (AMA (Automatic Message Accounting) The recording and reporting of telephone calls within a telephone system. It includes the calling and called parties and start and stop times of the call. ) to improve communications between physicians and health plans. The AMA plans to share the 10 voluntary guidelines with its member physicians. "Trigon Blue Cross Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. has been working to improve relations with network physicians for a number of years," said William William, crown prince of Germany William or Frederick William, 1882–1951, crown prince of Germany, son of William II. In World War I he commanded (1914) an army on the Western Front and was nominal commander in the German attack Bracciodieta, M.D., Trigon's senior vice president and chief health care officer. "We believe these guidelines will simply help us establish an even better dialogue between our company and participating doctors. Our company has always felt that physicians who care for and interact Interact can refer to:
Fall of Interact While the Game Boy device was first released, Interact acquired the rights to sell Datel's Action Replay daily with patients should be involved in shaping health plan policies that impact patient care." Following is a summary of the guidelines introduced by the BCBSA and Trigon initiatives already under way related to each one.
BCBSA GUIDELINE TRIGON INITIATIVE
--------------- -----------------
1. Health plans should involve 1. The Managed Care Advisory
participating provider Panel, a statewide medical
representatives in advisory committee that
clinically-oriented includes participating
decision-making committees physicians from all regions
and processes. of the state, provides
input on medical, quality
and business
matters affecting
physicians. In addition,
the Provider Policy
Committee of the Trigon
board of directors includes
practicing physicians in
addition to board members.
2. Credentialing and recredentialing 2. Trigon's Statewide
should be implemented by committees Credentialing Committee,
with representation from consisting of 41 providers
participating providers. (including mental health
providers) who represent
four areas of state,
approves credentialing
applications as well as
reviews utilization and
quality management issues.
3. All specialties participating in 3. Statewide Specialty Network
clinical process should be involved Advisory Panels made up of
in development of clinical practice local practicing physicians
guidelines and disease management advise Trigon's affiliated
protocols. HMOs on utilization
management, quality
improvement and
reimbursement programs.
These advisory committees
represent the following
specialties: obstetrics and
gynecology, dermatology,
orthopedics, gastro-
intestinal, cardiovascular,
urology and general surgery.
4. Participating providers must be 4. Trigon's physician contracts
able to discuss all treatment specifically encourage
alternatives with their discussion of all treatment
patients to enable them to alternatives with patients,
make informed decisions. without regard to whether
they are covered under the
patient's health plan or
not.
5. Access to a timely, expeditious 5. With 17 physician medical
internal appeals process. directors representing a
variety of specialties,
Trigon members' physicians
have prompt access to peer
physicians for discussion
of coverage decisions at the
time they are made, as well
as timely access to internal
appeals. In addition, if
disagreement over the
medical necessity for
coverage persists, Trigon
members and their physicians
may appeal to an
independent, external peer
physician. Finally, of
course, members insured by
Trigon also have access to
the state external review
process.
6. Peer review protections should 6. Peer review protections
extend to all sites of care. already extend to all
sites of care. Outpatient
surgical procedures receive
the same peer review as
inpatient procedures.
7. Participating provider 7. Trigon's Managed Care
representatives should be involved Advisory Panel, statewide
in the design of clinical data Credentialing Committee and
collections systems and Specialty Network Committees
interpretation of the data. provide this input. Trigon
shares profiling data with
physicians.
8. Participating provider 8. The Managed Care Advisory
representatives should be involved Panel, statewide
in identifying or developing Credentialing Committee and
meaningful quality assessment and Specialty Network Committees
improvement measures. provide input on quality
assessment and improvement.
9. All participating physicians should 9. The Managed Care Advisory
be informed of the identity of their Panel includes members of
representatives serving on organized medicine and is
clinically-oriented health plan composed of recognized
committees. physician leaders from
around the state.
Participating providers
know who these
representatives are.
10. Health plans should provide 10. All providers on Trigon
appropriate indemnity or insurance Committees are given
coverage to participating network appropriate indemnity or
provider representatives on insurance coverage for
committees. their decision-making
involvement.
The guidelines are part of a cooperative cooperative Organization owned by and operated for the benefit of those using its services. Cooperatives have been successful in such fields as the processing and marketing of farm products and the purchasing of other kinds of equipment and raw materials, and in the effort between the Blue Cross and Blue Shield Association and the AMA to increase interaction between local plans and participating physicians to help improve patient care. In a communication to its members, the AMA said the guidelines "lay the groundwork for what we hope are better and more meaningful relations in the future." Trigon believes such efforts serve to build greater trust and ensure better service to its members. "Physicians are the primary link between Trigon and our members," said Lynn Lynn, city (1990 pop. 81,245), Essex co., E Mass.; inc. as a town 1631, as a city 1850. Lynn is an old industrial center. The first ironworks (1643) and the first fire engine (1654) in the country were built there. Williamson Wil·liam·son , Mount A peak, 4,382.9 m (14,370 ft) high, in the Sierra Nevada of east-central California. , M.D., vice president and chief medical director at Trigon. "We recognize the critical importance of working together with our network doctors to provide our members with access to the quality health care coverage they value." Trigon is Virginia's largest managed health care company, providing a broad range of health, wellness and health care financing programs and services to approximately ap·prox·i·mate adj. 1. Almost exact or correct: the approximate time of the accident. 2. 2 million members. Visit us on the Web at www.trigon.com. |
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