Oakland Southfield Physicians

OSP News

Blue Cross Complete’s New Condition Optimization Prospective Outreach Program - How to Participate

Posted: 10/19/2021

 Identify and schedule members:

  • First, find eligible members in NaviNet by selecting Practice Documents, opening a member list, and filtering for the action indicator Please Schedule Appointment.
  • Once eligible members are identified, contact them to schedule an appointment. Please note: a letter will also be mailed to eligible members encouraging them to call and schedule an appointment with your office.

Complete scheduled visits and submit updates:

  • As scheduled visits occur, review any chronic condition(s) indicated for the patient on the Complex Case Management worksheet in NaviNet. Determine if the condition(s) still exist(s).
  • After the visit, please:
    • Complete the Complex Case Management worksheet in NaviNet.
    • Submit the medical record for the member visit by:
      • Fax to: 1-215-863-5694
    • Submit a claim through your normal billing process and include:
      • All diagnosed chronic conditions
      • Code 99499 with a modifier 25 and a billed amount of $150.00

Click here for more information and to register for a 1-hour webinar training session conducted by the Condition Optimization team.

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