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BLUECONNECT
Providers
June 2023
In This Issue
► June news: Executive summary
► Update your system to avoid obsolete drug codes
► Eligible providers can fast track prior auth requests
► Our AZBlue website redesign: Making it easier for you
► Updated HEDIS guidelines for hypertension
AZ Blue Navigators help Arizonans
who are no longer eligible for Medicaid
Controlling high blood pressure: Get up to date with new criteria for 2023
HEDIS® measures1 address a broad range of important health issues. Among updates for measurement year (MY) 2023 are changes to the Controlling High Blood Pressure (CBP) measure.2 Controlling high blood pressure is an important step in preventing heart attack, stroke, and kidney disease. In addition to prescribing medications, you can help patients with hypertension manage their blood pressure (BP) by encouraging them to follow a low-sodium diet, engage in more physical activity, and quit smoking.
Measure by measure: Guidelines for documenting hypertension

The CBP measure assesses adults 18-85 years of age with a diagnosis of hypertension and whose most recent BP reading during the measurement year indicates adequate control (<140/90 mm Hg). Both a representative systolic BP <140 mm Hg and a representative diastolic BP <90 mm Hg are required for compliance with this measure. If multiple readings are recorded during the same visit, the lowest systolic result and the lowest diastolic result can be used. The results do not need to be from the same reading.
Helpful handouts
For you: A Million Hearts® provider tip sheet to improve patient medication adherence

For your patients: Blood pressure fact sheets in English and Spanish from the American Heart Association
What's changed? Here's updated MY 2023 criteria

For MY 2023, HEDIS has:
• Added a required exclusion for members who died during the measurement year
• Replaced the reference to “female members” with “members” in the required exclusions
• Added a direct reference code for palliative care
• Updated the number of occurrences required for the frailty cross-cutting exclusion
Reducing the burden of HEDIS medical record reviews

Reporting BP results on claims using CPT® Category II codes allows for administrative capture of the results. In turn, this eases the burden on medical practices by reducing the volume of medical record reviews needed for the CBP measure during the HEDIS season.
Blood Pressure Reading Results CPT II Code
Systolic Blood Pressure <130 mm Hg 3074F
Systolic Blood Pressure 130-139 mm Hg 3075F
Systolic Blood Pressure > 140 mm Hg 3077F
Diastolic Blood Pressure < 80 mm Hg 3078F
Diastolic Blood Pressure 80-89 mm Hg 3079F
Diastolic Blood Pressure > 90 mm Hg 3080F
In This Issue
► June news: Executive summary
► Update your system to avoid obsolete drug codes
► Eligible providers can fast track prior auth requests
► Our AZBlue website redesign: Making it easier for you
► Updated HEDIS guidelines for hypertension
AZ Blue Navigators help Arizonans
who are no longer eligible for Medicaid
Blue Cross, Blue Shield, the Cross and Shield Symbols, MyBlue, BlueCard, Federal Employee Program, and FEP are registered service marks, and BluePathway and BlueJourney are service marks, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

More than 90% of America’s health plans, including Blue Cross® Blue Shield® of Arizona, use HEDIS to measure performance on important dimensions of care and service. HEDIS helps providers and health plans see where to focus their improvement efforts for higher-quality outcomes.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

CPT (Current Procedural Terminology) codes and modifiers are © 2023 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Million Hearts is a national initiative co-led by the CDC and CMS.

1 Source: NCQA, "HEDIS and Performance Measurement"

2 Source: NCQA, “Controlling High Blood Pressure (CBP)”

© 2023 Blue Cross Blue Shield of Arizona, Inc. All rights reserved.
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