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The scoop for ISMS practice management professionals

July 2018
In this Issue

  • Are You Experiencing Claim Denials When Using Modifiers -25 and -59?

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    ISMS has heard from some of you that clean claims are being automatically "edited" for review by Blue Cross and Blue Shield of Illinois (BCBSIL) when modifiers -25 and -59 are used. If the claim cannot be validated, the claim for the modifier will be denied.  

    The original procedure should be paid without edit. The edit only applies to modified services when using modifier -25 or modifier -59.  

    Beginning in November 2017, BCBSIL implemented code-editing software into its claim processing logic that validates modifiers included on submitted claims. This change is focused on modifiers -25 and -59. 

    The software edit being applied requires a practice to validate the use of the modifier on the claim. Therefore, for denied claims, file for reconsideration with medical records that provide support for the use of the modifier. Do not submit an "appeal" in this circumstance. Use the online Claim Inquiry Resolution (CIR) Tool to submit medical records for further review, or print out the Claim Review Form, complete and mail to the address on the form. 

    It is our understanding that if you send in the supporting data to BCBSIL for review and it is deemed appropriate, the denied claim should be released for payment. 

    Questions? As a practice management professional of an ISMS member, you may contact the ISMS advocacy team by calling 800-782-4767 ext. 1470, or by sending an email



  • Help Your Patients Get the Prescription Drugs They Need – Savings of Up to 75%

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    ISMS is excited to let you know about our new benefit partner – the Illinois Rx Card!

    The card is FREE and can save your patients up to 75 percent on their prescription drugs. 

    The Illinois Rx Card is pre-activated and can be used immediately at more than 68,000 participating pharmacies nationwide, including CVS, Walgreens, Walmart, Kroger, Kmart, SuperValu and many more.

    Prescription drug card highlights:

    • Everyone is eligible.
    • No limits on usage.
    • No health restrictions.
    • No paperwork to fill out.
    • Includes drugs not covered in your health plan.
    • Got any pets? The card also covers many pet prescriptions.
    • Save on both brand-name and generic drugs. 

    ALL Illinois residents are eligible to access this free statewide prescription assistance program. Doctors and medical office staff – even you are eligible, along with your family and friends. 

    Here's how to get started – just click or call: 

    1.   Create and print your discount prescription drug card coupon. You can share this link on your practice web site, in emails and through social media.

    2.   Printed cards and other materials can also be mailed to your patients at NO COST when they contact Illinois Rx Card Regional Manager Stacy Miller by phone at 888-615-1988or by email to make the request. You can staple the card to new paper prescriptions to help patients save money. 

    All that’s left to do is present the coupon card to any participating pharmacy to receive the discount. Your patients can create as many coupons as they wish and also send to friends and family members. 

    Spread the word about the Illinois Rx Card so your patients can start saving today!

    All prescriptions processed through this program are confidential.

    Check out other ISMS Benefit Partners.


  • Please Take a Brief Survey

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    ISMS is seeking your help via a brief four-question survey regarding the resources offered under the ISMS Benefit Partner program, along with the use and perceptions of these benefits.

    Take the survey now.  



  • Holding on Line 1 is a 17-Year-Old Married Patient. Minor or Adult?

    It can be a challenge to determine how to proceed when a minor calls or arrives at your office needing medical services and you do not have a parent's consent.

    Learn what to do by accessing ISMS' medical legal guideline, Parental Powers/Minors.* 

    The services and medical conditions covered in this guideline include:

    • Birth control services.
    • Sexually transmitted diseases and chemical abuse.
    • HIV.
    • Child and elder abuse and neglect reporting.
    • Minors of dissolved marriages. 
    • Medical and surgical services.

    As a practice management professional of an ISMS member, you may contact the ISMS Legal Department with questions by calling 800-782-4767 ext. 6485 or sending an email.  

    *This guideline is for educational purposes only.

    Need login help? 

    As a member benefit, this medical legal guideline is password protected. To access password protected materials, practice management professionals of ISMS members may request a username and password by contacting us.



  • Medical Practices Are Responsible for Protecting the Confidentiality of Their Patients

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    Today, it's more important than ever that medical practices ensure that their security policies and procedures safeguard protected health information.

    That’s why ISMS' offers Protecting Your Practice's Privacy & Security, an on-demand course covering policies and procedures that medical offices can develop and implement to align with HIPAA requirements. 

    This course is part of our growing stable of on-demand courses, available through the ISMS Education Center. The courses are available 24/7 and are FREE to members and their practice management professionals. All other pay $50. 

    Mention to your doctor that this on-demand course offers CME! 



  • New Medicare Cards Arriving Now to Illinois Beneficiaries!

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    Illinois postal carriers have heavy bundles of mail to be delivered to Medicare beneficiaries! The Centers for Medicare and Medicaid Services (CMS) has started to mail the new Medicare ID cards to those who live in "Wave 3 states," which includes Illinois.

    The expected 60 million new Medicare cards in the United States are being mailed in phases by geographic location. 

    To help curb identity theft, the Social Security number is being replaced by a Medicare Beneficiary Identifier (MBI). CMS will accept both the old cards with the Social Security number and the new cards with the MBI during a transition period from April 1, 2018, to Dec. 31, 2019. 

    Starting January 2020, CMS will only accept cards with the MBI.  

    Access a look-up tool to search for your patient's MBI. 

    View CMS'  Frequently Asked Questions



  • On the Legislative Front – Triumphant Year in Springfield!

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    By the time Illinois lawmakers wrapped up the spring session at the end of May, ISMS' priority bills had cleared the General Assembly and have since been sent to the governor's desk for consideration. 

    ISMS' legislative team worked hard in Springfield to achieve this stellar year of advocating on behalf of our members!

    For more details, read our article in Physician Advocate, Triumphant Year in Springfield.



  • Free Practice Management Help Available to Professionals Working for an ISMS Member

    As a practice management professional for an ISMS member, you have access to numerous resources.

    Need help with quality reporting, medical records, HIPAA privacy and security policies, credentialing or reimbursement? Are you experiencing difficulties or hassles with various government agencies and third party payers?

    The ISMS Division of Health Policy Research and Advocacy assists members and their staffs by decoding the myriad of rules and regulations that apply to the medical profession. Contact the team with your questions at any time by calling 800-782-4767 ext. 1470, or by sending an email

    ISMS also has a special content page for our practice management professionals.  

    You don't have to go it alone!




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