Blue Cross Blue Shield Vermont: FAQ's - Blue Quality Centers for Transplants (BQCT)

FAQ's - Blue Quality Centers for Transplants (BQCT)

Summary of Frequently Asked Questions:


•	What is Blue Quality Centers for Transplants (BQCT)?
•	What are the advantages of subscribing to the BQCT?
•	What transplant types are offered through the BQCT?
•	What does it cost to join the BQCT? How will my plan be billed?
•	What types of information will my plan receive annually regarding outcomes and cost savings?
•	What institutions are in the BQCT?
•	How do you select and credential facilities?
•	How often are credentialing and recredentialing of BQCT institutions performed?
•	What are the global rates for the institutions in my state?
•	Is the transplant evaluation included in the transplant rate?
•	How do I know if I can use the BQCT for a particular member?
•	Are there other restricitions in using the BQCT?
•	How are the claims for BQCT members filed?
•	What are the responsibilities of my plan's case managers?
•	Please describe the involvement of BQCT in obtaining information and coordinating care for the member.
•	Does the BQCT have a web site?

Q. What is Blue Quality Centers for Transplants (BQCT)?

A. The Blue Quality Centers for Transplants is a network of transplant institutions for bone marrow and organ transplants. The BQCT includes institutions that meet quality criteria and have agreed to a negotiated all-inclusive rate for a package of transplant services.

Q. What are the advantages of subscribing to the BQCT?

A. There are several advantages...

BQCT institutions undergo a stringent credentialing process. The development of selection criteria includes hospital site visits by a team of transplant physicians and nurses.
Referral Management. BQCT maintains a database of referrals and transplant cases. BQCT provides referral support to plan case managers through an 800 number.
Global package prices for defined episodes of care.
Request For Proposal Support. BQCT provides ongoing support to plans who are submitting RFPs to accounts, etc.
Claims Processing and Claims Resolution Support. BQCT provides ongoing support to resolve insurance claims issues.
Continuing education programs via conference call.

Q. What transplant types are offered through the BQCT?

A. BQCT offers seven individual networks: heart, heart/lung, lung, bone marrow (autologous and allogeneic), liver, pancreas and kidney-pancreas.

Q. What does it cost to join the BQCT? How will my plan be billed?

A. The BQCT annual subscription fee is based on a sliding scale of plan membership.

Q. What types of information will my plan receive annually regarding outcomes and cost savings?

A. On an annual basis, your plan will receive a Plan Activity Profile detailing the number of referrals, number of transplants, number of transplants with claims data from your plan including total charges, total BQCT rate, cost savings and average length of stay.

Q. What institutions are in the BQCT?

A. We can provide you with a list of BQCT institutions.

Q. How do you select and credential facilities?

A. Institutions are selected for the BQCT based on their ability to meet defined clinical criteria that are unique for each type of transplant. Panels of nationally recognized transplant researchers and physicians advise BCBSA on selection criteria that are periodically updated in response to medical advances. Institutions are surveyed for the information in many areas, including:

Volume of procedures
Duration of the transplant program
Patient outcome specific to the particular procedure
Transplant team training and experience
Facility licensure, accreditation, and transplant program certification
Patient selection process
Patient management protocol (treatment protocols for managing the patient's disease beginning with the pre-transplant evaluation through one-year follow-up post-transplant)
Education plan and support programs available for patient/family
Quality Assurance/Improvement program
Procedures for patient follow-up for at least 12 months post-transplant BQCT provides institutions with written surveys to initiate the credentialing process.

Fulfillment of the BQCT eligibility requirement for one type of transplant does not qualify an institution for participation for other types of transplants. Each institutional transplant program is evaluated independently against established criteria and is required to have an initial on-site evaluation prior to selection.

Q. How often are credentialing and recredentialing of BQCT institutions performed?

A. Once selected for participation, institutions are re-evaluated annually and are subject to periodic on-site reviews.

Q. What are the global rates for the institutions in my state?

A. Information pertaining to transplant rates by facility is confidential and proprietary until your plan has joined the BQCT. However, we will provide you with average rates for your geographic region.

Q. Is the transplant evaluation included in the transplant rate?

A. The pre-transplant evaluation is not included in the BQCT global rate, but is paid separately through the BlueCard Program.

Q. How do I know if I can use the BQCT for a particular member?

A. The member must have a Blues contract to be eligible to use the BQCT network.

Q. Are there other restrictions in using the BQCT?

A. Yes. Each plan must review its individual and group benefit contracts and plan medical policy considerations to determine if a particular member is eligible to use the BQCT for a transplant. The BQCT is available to help if questions of eligibility arise.

Q. How are the claims for BQCT members filed?

A. Each institution participating in the BQCT has received instructions to submit the complete global transplant claim for the defined episode of care in paper form to the identified BQCT contact for your plan. (The BQCT global claim is not sent through the local plan's ITS system for processing for your out-of-area transplant.)

Q. What are the responsibilities of my plan's case managers?

A. Your plan is responsible for all case management including precertification through concurrent review.

Q. Please describe the involvement of BQCT in obtaining information and coordinating care for the member.

A. BQCT receives the patient BQCT Referral Authorization Form completed by your plan's case manager and the Hospital Admission Form from the transplant institution. The plan case manager coordinates daily patient care.

Q. Does the BQCT have a web site?

A. Yes. The BQCT home page is located on the Blue Cross and Blue Shield Association's intranet web site at: http://blueweb.bcbs.com.