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Future Development of National Consumer Cost Tool for BCBSNC Members

In efforts to empower Blue Plan members in their health care decision-making process, Blue Cross and Blue Shield of North Carolina (BCBSNC) has partnered with other Blue Plans to help build the National Consumer Cost Tool (NCCT). NCCT is a new transparency tool that will provide estimated total cost information for some of the most common, elective services at hospitals, ambulatory surgery centers and imaging centers across the country.

Select Blues Plans will begin sharing this cost estimate data by use of the NCCT tool starting January 1, 2011. BCBSNC already offers to our members an online Health Care Cost Estimator through our secure site for members. In the next few years we'll make the transition and extend the NCCT cost estimate tool to BCBSNC membership and we'll share details with providers in advance of making that change.

The cost estimate information* available from the NCCT is derived from Blue claims data from Blue Plans across the country. With the launch of NCCT in the future, our members will be able to log into a secure cost tool on the BCBSNC web site, choose a treatment category, select a ZIP code and find facilities that offer the selected treatment along with estimated cost ranges. NCCT allows members to access average network cost ranges for a variety of common, elective treatment options and conditions, including facility, professional and ancillary procedures.

*The cost estimates are a guide and reflect the average claim allowed amount for the facility and any related physician or diagnostic/other related services included in the admission or outpatient date of service.

Through the NCCT, BCBSNC members will have the future availability to access cost estimates for the following procedures:

Treatment Category Code Treatment Category Type Code Procedure Name
00101 2 Bariatric Surgery - Laparoscopic Gastric Bypass
00201 2 Cardiac Angioplasty - with Drug Eluting Stent
00301 2 Cardiac Defibrillator Implant without Cardiac Catheterization
00401 2 Coronary Bypass (CABG) without Cardiac Catheterization
00501 2 C-Section Delivery
00502 2 Vaginal Delivery
00601 2 Hip Replacement
00701 2 Hysterectomy
00801 2 Knee Replacement
00901 2 Laminectomy - Inpatient
01001 2 Spinal Fusion (Anterior)
01002 2 Spinal Fusion (Posterior)
01101 1 ACL Repair by Arthroscopy
01201 1 Back Surgery - Laminectomy
01301 1 Bariatric Surgery (Lap Band)
01401 1 Bladder Repair For Incontinence (Sling)
01501 1 Breast Biopsy Percutaneous w/Imaging
01502 1 Breast Biopsy w/Device
01601 1 Breast Lumpectomy
01701 1 Bunionectomy
01801 1 Carpal Tunnel
01901 1 Cataract Removal
02001 1 Dilation & Curettage - D&C
02101 1 Hammertoe Correction
02201 1 Hernia Inguinal Repair 5 Years and Older
02301 1 Knee Arthroscopy with Cartilage Repair
02401 1 Laparoscopic Gall Bladder Removal
02501 1 Laparoscopic Removal of Ovaries and/or Fallopian Tubes
02601 1 Laparoscopic Tubal Block or Tubal Ligation
02701 1 Left Heart Catheterization
02801 1 Lithotripsy - Fragmenting of Kidney Stones
02901 1 Nasal/Sinus - Corrective Surgery – Septoplasty
03001 1 Nasal/Sinus - Endoscopy - Sinus Surgery
03101 1 Shoulder Arthroscopy
03102 1 Shoulder Arthroscopy with Rotator Cuff Repair
03201 1 Tonsillectomy and Adenectomy, under age 12
03301 1 Tympanostomy
03401 1 Upper GI Endoscopy
03402 1 Upper GI Endoscopy with Biopsy
03501 1 Colonoscopy with Biopsy
03601 1 Screening Colonoscopy
03701 1 Bronchoscopy
03801 1 Urethra and Bladder Scope
03901 3 Analog Mammography
04001 3 Digital Mammography
04101 3 CT Scan Abdomen
04201 3 CT Scan Head
04301 3 CT Scan Pelvis
04401 3 MRI Brain
04501 3 MRI Lower Limb
04601 3 MRI Spine
04701 3 MRI Upper Limb
04801 3 MRI Lower Limb with Joint
04901 3 Bone Density study of spine or pelvis
OFFICE VISITS - The first three digits identify the Treatment Category Group for the Web Service inquiry
(050)   Chiropractic
05001 4 Chiropractic treatment, including consultation, manipulation and therapy
(051)   Well Woman
05101 4 Periodic Well Woman GYN exam
(052)   Physician Care Existing Patient
05201 4 Physician Care Existing - Short visit (low to moderate severity)
05202 4 Physician Care Existing - Moderate visit (moderate to high severity)
05203 4 Physician Care Existing - Long visit (high severity)
(053)   Physician Care New Patient
05301 4 Physician Care New Patient - Short visit (low to moderate severity)
05302 4 Physician Care New Patient - Moderate visit (moderate to high severity)
05303 4 Physician Care New Patient - Long visit (high severity)
(054)   Pediatric Well Visits
05401 4 Pediatric Well Visit - Preventive checkup for a well child ages 1-11
05402 4 Pediatric Well Visit - Preventive checkup for a well child ages 12-18

Legend for Treatment Category Type Codes:

  1. - Outpatient Procedure
  2. - Inpatient Procedure
  3. - Diagnostic/Other
  4. - Office Visits

Prior to providing our members with access to this online information, we will invite you and/or your staff to review the data.

BCBSNC's implementation of the NCCT within the next few years presents an opportunity for BCBSNC to offer a secure, interactive environment where consumers can evaluate cost-related information and become better informed about the estimated costs of future procedures and participate more effectively in their health care decisions. We hope that you, as a trusted health care provider share our enthusiasm for the launch of this innovative member tool.

As always, we value your input and are open to your comments or any concerns. BCBSNC's regional Network Management representatives are available to discuss any questions or concerns you may have about the NCCT tool.