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Industry Updates – in case you missed them!

Blue Cross: Star Score Preview Coming Soon to Provider Insights
During the fourth quarter of 2024, Provider Insights will begin displaying a prospective star score for Quality. There will be a preview period through 2025 and become effective for scoring in the first quarter of 2026. This prospective star score will be used to determine the value-based payment for meeting Quality thresholds.

This impacts primary care providers, including pediatricians as the shift to star score methodology aligns with industry standards for representing a summary of quality performance.

What should you do during the preview period?

  • Review your prospective score in Provider Insights.
  • Continue to close gaps in care that impact that score.
  • Review how your score may change from the current point method to the composite star score.
  • Contact your Provider Engagement Consultant with any questions and to better understand how to improve your performance.

Need more Information? Go to the Star Score page and Provider Insights on Blue Cross ProviderAccess.

Blue Advantage: New Care Alerts for Patients with Multiple High-Risk Conditions
A new Care Alert has been added to notify you when a Blue Advantage patient with multiple high-risk conditions receives care in the Emergency Department. This new type of alert is intended to help offices close gaps in care for the Follow-up After Emergency Department Visit for People with Multiple High-Risk Conditions (FMC) Quality measures.

The following message will display for this new Care Alert:

A patient attributed to you with multiple chronic conditions has received care in an emergency room. Contact this patient to conduct a follow up service within 7 days of discharge.

Using the appropriate CPT code (99441-99443) for audio-only encounters will close the gap for this measure. Telehealth (for physicians and non-physician providers) may also close the gap. Refer to the guide for Quality measures for more information.