Blue CCHIP Update
 
April 2003 

The meeting was a great success with more than 40 states represented. 14 states with committee appointments or serving in advisory roles...

The Second Annual Blue CCHIP Meeting, Working From the Inside Out was held at NCLC on Friday, March 7, 2003.  The six-hour meeting offered an opportunity for Blue CCHIP liaisons, delegates and state associations to come together with ACA leadership and advisors and openly discuss the successes and roadblocks they have encountered.  The meeting was a great success with more than 40 states represented. 

For those of you who were unable to attend, I will include in this newsletter information and handouts that you did not receive.  In addition, I will be sending by mail a complimentary copy of our coding book, which includes all of our coding policies beginning on page 160.  These policies could be very useful in your talks with BCBS plans as they offer CPT-compliant coding policy that the Blues can use.  This will allow the Blues to have chiropractic policy as they make reimbursement decisions that treat DCs more fairly. 
 
The focus of this years meeting was to emphasize the need to continue working for internal BCBS committee appointments and to provide you, as liaisons, with the tools necessary to do so.  The meeting celebrated marked successes such as 14 states with committee appointments or serving in advisory roles.  In addition, the meeting outlined the 15 major successes the program has seen on the individual state level (please see the attached timeline), however, there is still a lot of work to be done.

A combination workshop was presented to both the Blue CCHIP meeting attendees and CAC Medicare representatives offering perspective about the operational philosophy of the insurance industry and giving suggestions for more effective relations.  In addition, Blue CCHIP attendees were brought up to date on materials being developed by ACA committees that will aid the liaisons in their work with local blues carriers.  One such material in development is the Clinical Documentation Book, which will help insurers and DCs better understand the correct way to document medical necessity, in addition, a feasibility committee has been set up to look at best practices.  Other presenters included Dr. Frank Stiso, New Jersey Liaison and Gene Veno, Executive Director of the Pennsylvania Chiropractic Association, two Blue CCHIP representatives who have had marked successes in spite of encountering tremendous roadblocks. 

The meeting ended with a Q&A session that allowed liaisons, delegates, and state associations in attendance to exchange ideas and information with each other, as well the program advisors, Dr. George McClelland and Dr. James Mertz.  Overall, the meeting exchange provided a great deal of valuable information to both liaisons and ACA staff supporting the program. 

We would like to thank all of our speakers; Dr. George McClelland, Dr. James Mertz, Tom Daly, Esq., Dr. Frank Stiso, Gene Veno, Dr. David Herd, Dr. Rick McMichael and Allan Liff as well as the liaisons, delegates and state associations involved with the Blue CCHIP program who were able to attend.  We hope that the rest of you will be able to join us next year! 

Meeting Handouts & Templates
Attached to this report you will find a variety of meeting handouts and templates that were discussed at the meeting.  These handouts have been listed below with comment for your information.  Please feel free to contact me at any time with any questions you may have regarding the meeting or handouts at cgriffith@amerchiro.org.  In addition, each liaison will receive a copy of our Coding Solutions Manual by mail which contains all of the information you will need for coding both in your office, as well as in your work with the Blues.  Be sure to check out all of the ACA Coding Policy, which you can share with the Blues, beginning on page 160.
Meeting Agenda: For reference
Conflict of Interest Form: Each liaison is required to return a completed copy of this form to ACA; at this point, the legal department has about half of your forms on file.  If you have not done so already, please fax or email a copy to the ACA Legal Department at 703-243-2593.
New Jersey Chiropractic Review Policy: Dr. Frank Stiso, New Jersey Liaison, submitted the following policy to Horizon Blue Cross Blue Shield earlier this year.  Please review and keep as a template for your work with your plan as policy input is warranted.  See the section below entitled First Medical Review Policy Proposal is Made for more information.
CMT Code 98943, Extremity Coverage: FYI
Quality of Care Resolution Proposal: FYI
Updated Contact Information for Blue CCHIP Manual: These two attachments contain the contact information for all BCCHIP liaisons as well as their contacts at the local plans.  Please review your state-specific information and let me know if there are any changes to be made so I can keep the list current. 
NEW - Meeting Report Template: With the rapid growth of the Blue CCHIP Program, we have put together the attached meeting template in an attempt to ease your reporting requirements.  All liaisons/delegates/state associations who are working with the blues should use this template.  Once filled in, the template can be sent to all involved parties (State Association/Delegate/Liaison/ACA) to keep everyone informed through one update.   
The template allows us to collect information we need about   attendees, meeting dates, etc.  This will insure that all necessary information is included in an efficient format that is easy to transition to our electronic database. 
Please use this template anytime you have a meeting with the blues, or at a minimum, on a quarterly basis to update ACA of what is going on in your state.  If nothing new has happened, simply indicate that on the update. 
NOTE: Please inform ACA of your meetings before they occur so we can get you any information you may need.  It would be very helpful if all updates could be sent by email.    

Letter to Mayo Clinic
At the request of Dr. Peter Spencer, California Liaison, ACA sent a letter to the Mayo Clinic requesting that they change the content of their website to give a more favorable outlook on chiropractic care.  At the same time, Tony Rosner, PhD, of FCER, sent a letter to Mayo as well making the same request.  The good news is that Mayo did make changes.  They changed the wording of sections that implied DCs needed to be supervised by MDs and the parts that said there is no evidence that chiropractors do better spinal manipulation than other health care providers.  However, they left in other sections that imply low back pain will simply clear up on its own in the time that chiropractic care would take to correct the pain.  At this point, ACA is drafting another letter to the Clinic asking them to again change their website to include research supporting chiropractic care.  ACA will offer to assist the clinic with this revision and ask for the chance to review any changes that are made.

First BCCHIP Medical Review Policy Proposal is Made
In the meeting handout section of this newsletter you will find the proposed Chiropractic Review Policy of Dr. Frank Stiso, New Jersey Liaison and Delegate, to the Horizon BCBS Medical Policy Committee.  While there may have been others prior to the beginning of the Blue CCHIP Initiative, Dr. Stiso was the first liaison to be appointed to a Medical Policy Making Committee after the program started.  As an appointee to this committee, Dr. Stiso has participated in many meetings and his persistence paid off when he was asked for input into the update of the plans Chiropractic Review Policy.  After several revisions to the plan and many meetings, the committee, including Dr. Stiso, worked out a plan they could all agree on.  The next step for the policy is to go through the Quality Improvement Committee before being approved.  While it does seem that this is a long and tedious process, it is certainly one that is worthwhile and will pay-off in the end.
Montana Representative Gets Appointed to  Medical Policy Making Committee!
Dr. John Sando, President of the Montana Chiropractic Association (MCA), was appointed to the Medical Policy Making Committee for BCBS of Montana just last week.  The appointment followed a meeting of ACA and MCA representatives with BCBS Montana in mid-February.  The meeting was held to discuss a wide range of on-going problems that did not seem to be addressed up to that point.  Prior to that meeting, there was a feeling of stagnancy that prompted the MCA to ask for ACA intervention.  ACA set up a meeting with the plan, as well as the local liaison and leadership from the Montana Chiropractic Association.  Following that meeting, the liaisons have plans to work with the local plan on the policy committee as well as through other avenues to address specific concerns.  Montana becomes the fifteenth state to be appointed to an internal blues committee or advisory role for the Blue CCHIP Program.