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BLUECONNECT
Providers
November 2023
In This Issue
► November news: Executive summary
► Important information about our 2024 HMO plans
► Register for a lifestyle medicine course at no cost
► Help increase the use of preferred biosimilar drugs
► Overview of diabetes measures for MY 2023
► AZ Blue fee schedule updates
Our Gold Card program makes prior auth easy for qualifying providers: Learn more!
Documenting diabetes care: Review the latest provider guidance and changes
HEDIS measures1 address a broad range of important health issues. These measures evolve and change over time. The Comprehensive Diabetic Care (CDC) measure consists of four stand-alone measures beginning measurement year (MY) 2023.
Measure by measure: Overview of the diabetes measures for MY 20232
Except where noted, each measure assesses the percentage of adults ages 18-75 with diabetes (type 1 and type 2) who received the following evaluations during the measurement year.
Guidelines for Kidney Health Evaluation for Patients With Diabetes (KED)
The goal of this measure is annual evaluation of kidney health for patients ages 18-85 with diabetes. A kidney health evaluation is defined as both an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR) performed with no more than four days between the service dates.
Guidelines for Blood Pressure Control for Patients With Diabetes (BPD)
The goal of this measure is adequately controlled blood pressure (<140/90 mm Hg) for patients with diabetes during the measurement year. Member-reported blood pressures that are documented in the medical record during the measurement year are acceptable. Note: When documenting repeat blood pressures, you may use the “best” systolic and “best” diastolic from the encounter. CPT® II codes should be used on the encounter claim to report this measure.
Guidelines for Eye Exam for Patients With Diabetes (EED)
The goal of this measure is regular evaluation for retinal disease for patients with diabetes by an eye care professional. Documentation in the medical record should include the date of service, type of examination performed, the result, and provider type. 
Guidelines for Hemoglobin A1c Control for Patients With Diabetes (HBD)
The goal of this measure is to monitor hemoglobin A1c (HbA1c) for adequate control in patients with diabetes. Adequate control is defined as HbA1c less than 8.0%. Poor control is defined as HbA1c greater than 9.0%. Documentation in the medical record should include the date the test was performed and the result. HbA1c reported as a range is not acceptable. CPT II codes should be used on the encounter claim to report this measure.
Updated MY 2023 criteria for the HBD measure 
The HBD measure was updated in the MY 2023 CMS final call letter. The measure is now calculated and reported for poor control >9%. This translates as an inverse measure, meaning a lower rate is better.
What’s changing for MY 20243
For MY 2024, the HBD measure will be changed to Glycemic Status Assessment for Patients with Diabetes (GSD). In addition to HbA1c measurement, the glucose management indicator (GMI) can be used to report member glycemic status to close the care gap.
In This Issue
► November news: Executive summary
► Important information about our 2024 HMO plans
► Register for a lifestyle medicine course at no cost
► Help increase the use of preferred biosimilar drugs
► Overview of diabetes measures for MY 2023
► AZ Blue fee schedule updates
Our Gold Card program makes prior auth easy
for qualifying providers: Learn more!
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.

1Source: NCQA, “HEDIS and Performance Measurement”
2Source: HEDIS MY 2023 Measures and Descriptions
3Source: HEDIS MY 2024 Measures and Descriptions

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.

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

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