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How the Trust Has Responded
Addressing Medicare Changes.
In 2014, the Trust staff continued to work diligently on bringing the Trust into compliance with new
claims rules from the Centers for Medicare and Medicaid Services (CMS). The rules are due to be
implemented in 2015. The Trust is on target for timely compliance with these new rules, which deal
with certain diagnostic and inpatient procedures, as well as the management of electronic health
care transactions.
CAQH CORE Operating Rules.
Another example of the Trust complying with governmental requirements is in the areas of electronic
funds transfer (EFT) and electronic remittance advice (ERA), each of which has operating rules that
mandated compliance by January 1, 2014. The Trust timely complied and is actively transmitting
EFT and ERA in accordance with regulation.
Contractual Savings.
For the Trust’s non-Medicare participants, a big advantage of selecting coverage under the Trust’s
PPO Option is the impact of network discounts available through Blue Cross Blue Shield under this
program. In 2014, these discounts produced savings on average of 50.4% off non-discounted
providers’ fees.
For non-Medicare participants who do not participate in the PPO Option, the Trust has a contract
with First Health to provide network discounts for participants should they utilize a participating
provider. The First Health network has helped the Trust and its participants realize savings on
average of 30% off non-discounted providers’ fees.
Medicare Part D Subsidy.
The Trust received $2.98 million from Medicare for its sponsorship of a prescription drug program
that is at least as valuable as the Medicare Part D program.
Disease Management Program.
The Nurtur disease management program is another example of an important investment for the
Trust and its participants. The program is designed to help participants manage their disease, avoid
hospitalizations and improve their quality of life. The Trust pays Nurtur for each participant who uses
the program.
To date, participants with diabetes continues to be the largest group in the program. The program is
assisting these participants by having them work with a registered dietitian and a certified diabetes
educator to create meal plans and set goals for increasing their physical activity. 52% of the
participants were at goal or improved in their exercise outcomes.
Evolving Automation with Personalization.
The Trust’s systems and procedures are highly automated to assure the best possible levels of
accuracy and personalized participant service, while reducing administrative costs. Still, every caller
is greeted by a Trust staff member, and many participants comment on the importance of that
personal touch. The Trust staff continually reviews software, equipment and procedures to improve
the operations and reduce administrative costs.
