Provider Focus - May 2009 - Blue Cross Blue Shield of Massachusetts

May 2009
Providerfocus
Published Monthly for Physicians, Health Care Providers, and Their Office Staff
Technology Plays a Vital Role in Improving the Quality of Health Care
During her confirmation hearing,
Secretary of Health and Human
Services Kathleen Sebelius said
health information technology “lays
the foundation for a 21st-century
system to reduce medical errors,
lower health care costs, and empower
health consumers.”
Blue Cross Blue Shield of
Massachusetts (BCBSMA) has long
supported e-health initiatives in
Massachusetts, through our involvement
with the Massachusetts
eHealth Collaborative and the eRx
Collaborative. That’s because we
believe the most promising way to
control health care costs is by
improving the quality of care, and
that technology plays a crucial role
in achieving this goal.
As part of BCBSMA’s goal of increasing
the safety, quality and affordability
of patient care in Massachusetts,
in 2008 we announced that we
would require providers to prescribe
medications electronically to qualify
for any of our physician incentive
programs starting in January 1, 2011.
A recent study, Adoption of
Electronic Health Record
2
4
5
7
In This Issue
Reminder for PCPs on
Panel Status and After-
Hours Reimbursement
Recredentialing Tips for
Behavioral Health
Providers
Functional Rating Index
Tool Online for
Chiropractic Practices
Medical Policy Update
Capabilities in Massachusetts
Physician Practices* examines
physicians’ use of basic and
advanced electronic health record
(EHR) capabilities.
Of the 519 physicians surveyed
(roughly 3% of Massachusetts physicians):
36% said they use all “basic”
EHR capabilities, such as electronic
medication and problem
lists, and functionality to order
prescriptions electronically.
5% claimed adoption of all
“advanced” EHR capabilities,
including disease management
and health maintenance functionality.
Nearly 75% said they order prescriptions
electronically for at
least some of their patients.
66% regularly transmit prescriptions
electronically to pharmacies
via fax or computer.
“The research clearly shows the
progress that has been made in the
state to increase adoption of clinical
information technology,” said Greg
In Brief
LeGrow, BCBSMA’s Director of e-
Health Innovation. “We still have a
way to go, but the results are
encouraging and demonstrate the
impact aligned efforts can have to
further the use of technology that
improves the quality and affordability
of care delivered.”
Joining the Technology Movement
To assist prescribers who have not
adopted this technology, BCBSMA
is sponsoring new e-prescribing
licenses on a first-come, first-served
basis in 2009 to selected prescribers
who have not received prior sponsorship
from the eRx Collaborative or
BCBSMA.
In addition, the Centers for
Medicare & Medicaid Services is
offering incentive payments this
continued on page 3
New Google Health Online Training Available
As we’ve reported in Provider Focus,
BCBSMA members can now safely
import their health history and other
health data into a secure online
Google Health personal health
record free of charge.
Learn how Google Health can help
members organize their health
history and share it with providers
by completing our new online
training course.
Signing Up for Training Is Easy!
To register, log on to our website at
www.bluecrossma.com/provider
and select Resource Center>
Training & Registration>Course
List, then select About Google
Health.

Physician News
Attention PCP Offices: Reminders on Panel Status, After-Hours Reimbursement
BCBSMA values the services that primary care physicians
(PCPs) provide in managing our members’ total
care. During this time when PCPs are in high demand,
we would like to remind you of our guidelines for PCP
office practice.
Panel Designations
If you have an open panel, we expect it to be open for
all BCBSMA members. We appreciate when PCPs are
able to maintain an open panel status for new patients to
help ensure that our members have access to the care
that they need. Please also note that 90-day written
notice is contractually required when closing your panel
to new members.
If you have closed your panel to new members, but it is
open to existing members:
You will not be listed on the Find a Doctor section
of our website as a participating PCP for members
to choose.
Your existing patients, who may change from one
health plan to a BCBSMA managed care product,
may continue to have you listed as their PCP.
Our expectation is that your panel is closed with all
health plans, not just with BCBSMA.
If you have closed your panel to both new members and
existing members:
You will not be listed on the Find a Doctor section
of our website as a participating PCP for members
to choose.
Our expectation is that your panel is closed with all
health plans, not just with BCBSMA.
Your existing patients, who may change from one
health plan to a BCBSMA managed care product,
will not be able to continue with you as the PCP, as
your panels are closed for both new and existing
members.
No managed care members will be added to your
panel and members requesting to be added to your
panel will be advised to select another PCP with an
open panel.
If you have questions about your current panel status,
please log on to www.bluecrossma.com/provider and
click Manage Your Business>Find a Doctor or call
our Provider Enrollment area at 1-800-419-4419.
Reimbursement for Sundays, Major Holidays
We will continue to reimburse participating physicians
for CPT ®´´ code 99050 (Services requested after posted
office hours in addition to basic service). Major holidays,
for which this code would apply, include only the following
six holidays:
New Year’s Day
Memorial Day
Independence Day (July 4th)
Labor Day
Thanksgiving Day
Christmas Day.
InterQual ®´´ Behavioral Health and Medical/Surgical Level of Care Criteria Now Available Online
Our Medical Review Resources page now gives you Determine prior to rendering services whether
access to the InterQual ®´´ Behavioral Health and
the services meet the InterQual ®´´ criteria.
Medical/Surgical Level of Care Criteria. The new
page enables providers to use a set of drop-down To access the Level of Care Criteria, log on to
menus to access the InterQual ®´´ Level of Care Criteria www.bluecrossma.com/provider and select
for your patient—our members.
Manage Your Business>Medical Review
Resources>InterQual ®´´ Behavioral Health and
Medical-Surgical Level of Care Criteria. To
As a reminder, BCBSMA uses InterQual ®´´ criteria to
make medical necessity determinations. Referring to
the criteria may help you:
Understand how BCBSMA made a medical
necessity determination for a service that has
been rendered, or
submit an InterQual ®´´ SmartSheet TM for a procedure
that requires prior authorization, select McKesson
InterQual ®´´ SmartSheets from the Medical
Review Resources page.
2
Providerfocus • May 2009

Member Education
BCBSMA Offers Wellness Tools to Empower Our Members
To help our members make the
connection between lifestyle habits
and their long-term health, we
offer a suite of wellness programs
that empower them to make
informed, healthy choices.
We recently enhanced our wellness
website to provide an integrated
set of services designed to help
make behavior changes and
improve members’ overall health.
At www.mybluehealth.com,
members can find our wellness
solution, which includes:
Health assessments
Lifestyle management tools
Online coaching tools
Personalized diet and exercise
plans
A library of health and wellness
articles, tips and recipes
Online communities
Access to discounted networks
of complementary and alternative
health providers.
Technology Plays a Vital Role in Improving the Quality of Health Care
continued on page 3
year to early adopters of e-prescribing
technology; providers who
delay use of e-prescribing technology
will be penalized for noncompliance.
The incentives are intended
to offset the costs of implementing
the new technology—
about $3,000 to adopt, and monthly
costs of $80 to $400 to maintain.
The American Recovery and
Reinvestment Act signed by
President Barack Obama includes
$19 billion to jump-start health
care IT efforts over the next several
years. The funding is another
step the government is taking to
support health care providers in
adopting technology.
For information on:
CMS’ e-prescribing incentive
program
Massachusetts Health Data
Consortium
eRx Collaborative
MassPro
BCBSMA’s 2009 e-prescribing
program
Go to:
Guidance and education about
how to implement e-prescribing
technology or EHRs, is offered by
MassPro, a federally designated
health care Quality Improvement
Organization, and the CMS
Doctor’s Office Quality-
Information Technology (DOQ-
IT) initiative, which provides consulting
services to physician
groups in the state to expedite the
adoption of electronic health
records. Masspro has successfully
enrolled more than 1,500 physicians
from more than 450 practices
in the CMS DOQ-IT initiative.
* The survey was conducted in the summer of
2008 by CSC and sponsored by BCBSMA. Go to
www.csc.com/ physician_study_09 for more
details.
www.cms.hhs.gov/erxincentive
www.mahealthdata.org
www.erxcollaborative.org
www.masspro.org
www.bluecrossma.com/provider; log
on and click Resource Center>Admin
Guidelines & Info>Fact Sheets
3
Providerfocus • May 2009
eRx Collaborative: A Conduit
for Technology Adoption
The eRx Collaborative has been
working since 2003 to improve
patient safety and increase health
care affordability by underwriting
the cost and promoting the adoption
and utilization of e-prescribing
technology in Massachusetts.
The Collaborative has provided
funding for more than 5,600 prescribers;
those prescribers have
sent 17.8 million e-prescriptions
since the start of the program.
In 2008 alone:
The Collaborative deployed
350 new prescribers during
the year, surpassing the year’s
goal of 200 new prescribers.
Collaborative prescribers sent
4 million e-prescriptions
Approximately 82,600 e-prescriptions
were changed due
to drug safety alerts (2% of
the e-prescriptions written).
Though no longer sponsoring
renewals or new licenses in 2009,
the Collaborative will refocus its
efforts to promote e-prescribing in
Massachusetts through education
and engagement of physicians,
vendors, and consumers.

Behavioral Health Highlights
Recredentialing Tips for Behavioral Health Providers
Q. How often does BCBSMA
recredential providers
A. BCBSMA recredentials professional
providers every two years
based on the provider’s birth date.
For example: If you are scheduled
to be recredentialed this year and
your date of birth is June 12, 1969,
your recredentialing application is
due June 1, 2009.
Q. How will I be notified about
recredentialing
A. You will receive an automatic
reminder via fax, mail, or e-mail to
your address that’s on file with the
Council for Affordable Quality
Healthcare (CAQH). You will be
asked to review, update, and attest
to the accuracy of your data. To
streamline the recredentialing
process for all behavioral health
providers, BCBSMA no longer
requires two reference letters,
except for MDs who do not have
hospital privileges.
Q.What documentation is required
A. In addition to those listed on the
recredentialing application, psychiatric
nurse practitioners must
attach a copy of his/her accreditation
certificate from either the
American Nurses Credentialing
Center or the American Academy
of Nurse Practitioners.
Q.What happens if I don’t review
and update my information
A. If you do not respond to
CAQH’s information request, your
contract with BCBSMA will be terminated.
If we do not receive your
information within 30 days of contract
termination, you will be
required to go through full initial
credentialing, which would require
the completion of a new contracting
application and the submission
of two letters of reference.
Q. If I am not due for recredentialing,
but my address or other information
changes, how do I update the
information on file with CAQH
A. You can change your provider
information on file with CAQH at
any time. Because all recredentialing
notifications are sent to the
address CAQH and BCBSMA have
on file, it is important to notify
both CAQH and BCBSMA of any
changes to your information.
Please Note: We recommend that
you re-attest every 120 days to
verify that your information is
up-to-date. To do this, simply go to
https://upd.caqh.org/oas or
call the CAQH help desk at
1-888-599-1771. The help desk
can also assist you with login
information.
If you have any questions about
recredentialing application packages,
please call Provider Enrollment and
Credentialing at 1-800-419-4419.
State Mental Health Parity Law Goes Into Effect July 1, 2009
The State Mental Health Parity
Mandate will be implemented
effective July 1, 2009, and will
apply to all fully insured accounts
and administrative service contract
accounts with contracts that currently
cover benefits at the biological
level for:
Affective disorders
Bipolar disorder
Delirium and dementia
Major depressive disorder
Obsessive-compulsive disorder
Panic disorder
Paranoia and other psychotic
disorders
Schizoaffective disorder
Schizophrenia
Effective July 1, 2009, the following
four disorders will be reclassified
as biologically-based, and will
be covered as biologically-based, in
addition to the nine conditions listed
to the left:
Autism
Eating disorders
Post-traumatic stress disorder
(PTSD)
Substance abuse.
This change means that all of these
disorders will be treated the same
as medical and surgical benefits
and will not have visit maximums
or capitation on dollar amounts if
no such limits apply to similar
4
Providerfocus • May 2009
treatments for medical and surgical
conditions.
As always, we urge you to use one
of our provider technologies to
check eligibility and benefits
before delivering services.
Upcoming Federal Mental Health
Parity Changes
These state-level changes come in
advance of an important change
regarding behavioral health coverage
that will be addressed in the
new federal Mental Health Parity
Act, which will go into effect in
October 2009. We’ll provide more
details about the federal change in
a future issue of Provider Focus.

Behavioral Health Highlights
Update on Neuropsychological Testing Authorization
Requirements
Our January 1, 2009 F.Y.I. regarding
changes to neuropsychological testing
authorization requirements noted
that the requirement would become
effective for members of our POS
product for both in-network and outof-network
care starting on May 1,
2009. As clarification, the requirement
will not apply to POS members
who seek out-of-network care.
Also, BCBSMA has decided to modify
the approval range to a minimum
of eight units, rather than the previously
announced minimum of six
units. Depending on the complexity
of the required testing, prior authorization
requests will be approved
within the following ranges based on
medial necessity:
8-12 hours for children
8-12 hours for adolescents, rather
Ancillary News
than the previously announced
range of 6-10 units
8-10 hours for adults.
To access our F.Y.I. and resources
related to this requirement, log on to
www.bluecrossma.com/
provider and click on the
Neuropsychological Testing window
on the right side of the home page.
Prior authorization is not required for
neuropsychological testing associated
with acute inpatient medical or inpatient
behavioral health care. Testing
at all other levels of care does
require prior authorization.
If you have questions, please e-mail
your Provider Relations Manager at
behavioralhealth@bcbsma.com or
call 1-800-316-BLUE (2583),
Option 3.
Chiropractic Services Authorization Program Training
Join representatives from BCBSMA
and our vendor, Healthways
WholeHealth Networks, Inc.
(HWHN), for an in-person seminar
or online webinar about the chiropractic
services authorization program.
We will offer three training
sessions, in which you will learn:
How the program has been
updated in 2009
How to use HWHN’s telephonic
and web-based tools to submit
authorization requests
How to check member eligibility
and benefits
About the criteria HWHN uses
to make authorization decisions.
To register, log on to
www.bluecrossma.com/provider
and select Resource Center>
Training & Registration>
Course List>Chiropractic
Authorization Program Training
(under the Ancillary subheading).
Location: Date: Time:
BCBSMA
One Enterprise Drive
Quincy
Webinar
Wednesday, June 10, 2009
Thursday, June 11, 2009
Wednesday, June 10, 2009
10:30 a.m. - noon
10:30 a.m. - noon
2 p.m. - 3 p.m.
5
Providerfocus • May 2009
Date Extended for Applying
to Our Managed Care
Behavioral Health Network
We previously announced that
our Managed Care Behavioral
Health (MCBH) network would
be open until May 1, 2009 to
psychologists who indicate on
the application that they are
qualified to provide neuropsychological
testing services to
BCBSMA members and are
accepting referrals. We are
extending this invitation
beyond May 1, 2009 until you
receive further notice from
BCBSMA. Log on to
www.bluecrossma.com/
provider and select News for
You>FYIs for more information.
Functional Rating Index (FRI)
Tools Posted Online for
Chiropractic Practices
Our FRI tools are available as
PDF files on BlueLinks for
Providers. You can easily copy
the files and post them on you
practice’s website. Then, your
patients can download and
complete the questionnaire
prior to the appointment. Log
on to www.bluecrossma.com/
provider and select the blue
box marked Chiropractic
Services Authorization
Program on the right-side of
the page. The PDFs can be
found in the pop-up window.
The tools are available in
English, Spanish, and
Portuguese.

Billing Notes
Individual Consideration Tips: Using a Not Otherwise Classified (NOC) Code
To submit an individual consideration
appeal with a NOC code,
please complete our Provider
Appeal Form, and submit it with
the required documentation and a
detailed description of services
performed; otherwise, you will be
asked to resubmit the appeal with
the required information. (The
entire medical record is not
required.)
To download the Appeal Form, log
on to www.bluecrossma.com/
provider and click on Resource
Center>Forms>Review and
Appeals.
Previous NOC Codes That Now
Have a CPT/HCPCS Code
We have been receiving appeals
with NOC codes for services that
now have a listed HCPCS or CPT
code. To help expedite the payment
process, please review the
table below and update your
records to reflect these codes.
If you submit an appeal with a
NOC code for a service that has an
HCPCS or CPT code, we’ll return
your appeal and request that you
revise and resubmit the claim.
Code:
29828
43273
43279
49652
49653
49654
49655
49656
49657
58541
58542
58543
58544
64650
64653
95992
S2083
S2117
S2118
S8037
Narrative:
Arthroscopy, shoulder, surgical; biceps tenodesis
Endoscopic cannulation of papilla with direct visualization of common bile duct(s) and/or pancreatic
duct(s) add on code (List separately in addition to code(s) for primary procedure. Use 43273 in conjunction
with 43260, 43261, 43263-43265, 43267-43272)
Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when performed
Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion,
when performed); reducible
Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion,
when performed); incarcerated or strangulated
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or
strangulated
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed);
reducible
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed);
incarcerated or strangulated
Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less
Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or
ovary(s)
Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g
Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s)
and/or ovary(s)
Chemodenervation of eccrine glands; both axillae
Chemodenervation of eccrine glands; other area(s) (e.g., scalp, face, neck), per day
Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day
Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline
Arthroereisis, subtalar
Metal-on-metal total hip resurfacing, including acetabular and femoral components
Magnetic resonance cholangiopancreatography
6
Providerfocus • May 2009

Medical Policy Update
Access the latest updates to medical
policies and other documents via:
www.bluecrossma.com/
provider; click Medical Policies.
Fax-on-Demand at 1-888-633-7654
Changes
Autologous Chondrocyte
Implantation, 374. Adding coverage of
autologous chondrocyte implantation
for identified medically necessary
indications and criteria to align with
Blue Cross Blue Shield Association
national policy. Effective 8/1/09.
Osteochondral Allograft and Autograft
Transplantation, 111. New medical
policy, aligning coverage and noncoverage
of osteochondral allograft
and autograft transplantation with
BCBSA national policy. Effective
8/1/09.
Spinal,Vagal, Deep Brain, Cerebellar
Stimulation, 083. Managed care
guidelines: Authorizations are
required for outpatient services with
the exception of spinal cord stimulator
trials. Effective 8/09.
TENS, PENS/PNT, and NMES, 003:
Managed Care guidelines:
Referrals are not required for
Medicare HMO Blue ® members,
however, the device must be
medically necessary, prescribed
by a plan physician, and provided
by a network provider. For all
other Managed Care plans, any
specialist visit requires a referral,
except for visits performed by
OB/GYN specialists. Authorizations
are not required. Authorizations
are required for outpatient
services.
Indemnity and PPO
guidelines: Authorizations are
required for most outpatient services
as determined by the individual’s
subscriber certificate.
Effective 8/09.
Clarifications
Maze Surgery, 356. Clarifying coverage
of CPT code 33257, operative
tissue ablation and reconstruction of
atria, performed at the time of other
cardiac procedure(s), limited (e.g.,
modified maze procedure). Effective
3/09.
Medical Technology Assessment Noncovered
Services, 400.
Clarifying coverage for CPT ®´´
code 33257, effective 3/09.
Clarifying the non-coverage for
SonoCine ®´´, Adjunctive Breast
Ultrasound System model 100.
Multiple Sleep Latency Testing (MSLT)
and Maintenance of Wakefulness
Testing (MWT), 102. Implementation
of a new medical policy (previously
announced in March 2009 Provider
Focus) has been postponed. Please
continue to use medical policy 293,
Sleep Disorders, for coverage and noncoverage
of multiple sleep latency
testing. Also, please see medical policy
400, Medical Technology Assessment
Guidelines Non-Covered Service, which
clarifies non-coverage for maintenance
of wakefulness testing.
Effective 6/1/09.
Osteochondral Allograft and Autograft
Transplantation, 374. Removing coverage
information on osteochondral
allograft and autograft transplantation
with notation to see new medical
policy (Osteochondral Allograft and
Autograft Transplantation, 111).
Effective 8/09.
Polysomnography, 094.
Implementation of a new medical
policy has been postponed. Please
continue to use Sleep Disorders (medical
policy 293) for coverage and
non-coverage guidelines for
polysomnography and sleep studies.
Tumor Markers, 167. Clarifying covered
indications for BTA stat ®´´ or
NMP-22 to include new 2008 ICD-
9-CM diagnosis codes 599.70 (hematuria,
unspecified) and 599.72
(microscopic hematuria). Reminder:
Coverage is based on the criteria
defined in the medical policy.
Correction
The Medical Policy Update
page in the February 2009 issue
of Provider Focus incorrectly
listed the medical policy
number for Iontophoresis as 094.
The correct number is 095. To
view this medical policy, go to
www.bluecrossma.com/
provider and click on Medical
Policies.
Check Out Our Improved Medical Policy Page on BlueLinks for Providers
We’re always looking for ways to
improve our website to make it
work better for you. One request
we’ve heard from providers is an
easier way to search for medical
policy information.
To help you find the information
you need quickly, we’ve added a
search tool to the Medical Policy
page on our website. Go to
www.bluecrossma.com/
provider and click on Medical
7
Providerfocus • May 2009
Policies. Then, simply type a subject,
condition, treatment, or document
number into the Quick
Search box on the right side of the
page to obtain a listing of related
medical policies.

Providerfocus
Landmark Center
401 Park Drive
Boston, MA 02215
PRESORTED
STANDARD MAIL
U.S. POSTAGE
PAID
BOSTON, MA
PERMIT NO. 56717
ROUTING BOX
Date received:____________
Please route to:
Office manager
Physician
Nurse
Billing manager
Billing agency
Receptionist
Other: __________________
___________________________
Want to receive payment faster
Sign up for direct deposit through PaySpan Health. Call 1-800-771-4097.
Important Update
Addresses for Provider Appeals Have Been Consolidated
To help reduce administrative
expenses, BCBSMA will be consolidating
our Provider Appeals
addresses into one address for all
professional and ancillary providers
(including oral surgeons and behavioral
health providers), and for all
facilities.
Effective July 1, 2009, all appeals
should be sent to:
Provider Appeals
BCBSMA
P.O. Box 986065
Boston, MA 02298
P.O. boxes 986070 and 986075
will expire June 30, 2009. To
prevent any delays in processing
your claims, please begin using the
new addresses immediately. If you
use software to print claim forms or
any other communications that
contain a BCBSMA address, please
make the necessary changes to
your system.
We will update our Blue Book manual,
forms, and other provider documents
to reflect this change.
If you have any questions, please
contact your Provider Relations
Manager at 1-800-316-BLUE
(2583).
Providerfocus is published monthly for
BCBSMA physicians, health care providers, and
their office staff. Please submit letters and suggestions
for future articles to:
Editor, Provider Focus
Provider Education and Communications
Blue Cross Blue Shield of MA
Landmark Center, MS 01/08
401 Park Drive
Boston, MA 02215-3326
—or—
E-mail: focus@bcbsma.com
● Cleve L. Killingsworth, Chairman and
Chief Executive Officer
● Andrew Dreyfus, Executive Vice President,
Health Care Services
● John A. Fallon, M.D., Chief Physician
Executive and Senior Vice President
● Steven J. Fox, Vice President, Provider
Network Management
● Teresa Perrier, Editor
●Patricia Gaudino, Managing Editor
● Stephanie Botvin, Contributing Writer
● Jennifer Harding, Contributing Writer
● Barbara Chester, Production Manager
● Patricia Moriarty, Graphic Designer
BCBSMA refers to Blue Cross Blue Shield of Massachusetts and Blue Cross Blue
Shield of Massachusetts HMO Blue ® , Inc., based on Product participation. © 2009
Blue Cross and Blue Shield of Massachusetts, Inc. and Blue Cross and Blue Shield of
Massachusetts HMO Blue ® , Inc. ® Registered marks of the Blue Cross and Blue Shield
Association. ®´ and SM Registered marks of Blue Cross Blue Shield of Massachusetts.
®´´ and TM Registered marks of their respective companies. PEP-1914V(5/09)