BCHC Basics A Guide for Clinics Delivering BCHC Services Table

							          BCHC Basics: A Guide for Clinics Delivering BCHC Services


Table of Contents

Program Overview                                                             2

Provider Roles and Responsibilities                                          2
   Screening Providers                                                       2
   Imaging and Clinical Consultant Providers                                 3
   Laboratories                                                              3
   Anesthesiologists                                                         4
   Recruitment                                                               4

Client Eligibility and Enrollment                                            4
   Eligibility                                                               4
   Completion of the BCHC Annual Enrollment Form                             5
   Special Notes Regarding Enrollment of Insured Women                       5

Delivery of Clinical Services                                                6
   Cervical Cancer Screening                                                 6
   Breast Cancer Screening                                                   7
   Referring for Imaging or Clinical Consultation                            7
   Travel for Diagnostic Evaluation                                          8
   Case Management                                                           8
   Referring for Treatment Coverage                                          8
   Requirements for Tracking Clients for Follow up                           9
   Notifying Clients of Clinical Results                                    10
   Contacting Clients for Re-screening                                      10
   Special Note Regarding Data Collection Forms                             10

Submitting Client Information to BCHC                                       11

Reimbursement and Billing                                                   11
   Other Health Care Coverage                                               13
   Reports Regarding Pended Claims                                          13
   Special Fees Paid to Screening Providers                                 14

Recruitment: Inreach and Outreach                                           14

Quality Assurance and Quality Improvement                                   15

Contacting BCHC                                                       last page




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             Program Overview

Breast and Cervical Health Check (BCHC) is the State of Alaska’s Breast and Cervical
Cancer Early Detection Program. It is supported by funding from the Centers for
Disease Control and Prevention (CDC) and the State of Alaska, Department of Health
and Social Services.

BCHC provides funding for breast and cervical cancer screening and diagnosis for
women with limited incomes who have little or no health insurance. See Client
Eligibility and Enrollment for details.

BCHC pays for breast and cervical cancer screening and diagnosis services for enrolled
women when these services are performed by providers with agreements with BCHC.
See Provider Roles and Responsibilities and Reimbursement and Billing for
details.

BCHC Basics is a guide to operation of the program in provider clinics. In addition to
this guide, other important information about the program is contained in the following
more special purpose documents:
     • BCHC Provider Agreement
     • BCHC Clinical Guidelines
     • BCHC Listing of Approved CPT Codes
     • BCHC Clinical Resources List
If there are questions beyond the information presented in these documents, contact
BCHC. See Contacting BCHC at the end of this guide.




             Provider Roles and Responsibilities

BCHC has identified specialized roles for delivery of its clinical services. Providers who
serve as client care managers for BCHC clients are referred to as “screening” providers.
Providers offering specialty services including imaging, laboratory, and breast or
cervical specialist consultation are clinical resource providers.

Screening Providers
The principal agent upon which BCHC relies is the screening provider. BCHC
screening providers bring women into the program, enroll them, and facilitate their
access to diagnostic services when needed, by referring them to BCHC imaging or
consulting providers.



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Screening providers:
   • Enroll and screen women;
   • Refer women to BCHC clinical specialists or imaging facilities as needed;
   • Assure that clients with suspicious for cancer, or pre-cancerous, clinical results
     complete a diagnostic work up within 60 days of the initial abnormal finding;
   • Assure that clients needing treatment for cancer or pre-cancerous conditions
     initiate treatment within 60 days of their diagnosis;
   • Report clinical information as requested by BCHC;
   • Designate one person from their staff to fill the role of BCHC Primary Contact.
     The BCHC Primary Contact has primary responsibility for completing and
     submitting BCHC data forms and responding to information requested on monthly
     follow-up reports and lists. The Primary Contact is responsible for coordinating
     BCHC service delivery at the screening provider site, including enrollment,
     screening services, case management, tracking systems and reporting of data.
     While other staff may provide direct clinical care or be responsible for actively
     case managing clients, the Primary Contact is the on-site point person for all
     service delivery functions.

Imaging and Clinical Consultant Providers
The role of BCHC imaging and clinical consultant providers is limited in comparison to
that of the screening provider. Imaging and clinical consultant providers accept referrals
from screening providers for BCHC clients needing services not available at the
screening provider site. Imaging and clinical consultant providers are responsible for
reporting their clinical findings both to the screening provider who originally referred the
client, and to BCHC.

Imaging and clinical consultant providers:
   • Receive referrals from BCHC screening providers requesting clinical evaluation
      of BCHC women screened in the program;
   • Provide a written report documenting their findings and recommendations to the
      referring screening provider;
   • Report their clinical findings to BCHC by submitting a copy of clinical notes or
      reports;
   • Submit claims to BCHC for approved services as listed on the BCHC Listing of
      Approved CPT Codes;
   • Do not submit BCHC clinical data collection forms;
   • Do not enroll women into BCHC.

Laboratories
BCHC participating laboratories may:
   • Submit courtesy copies of reports to BCHC at the request of screening or clinical
      consultants;
   • Bill BCHC directly for services, or
   • Allow screening or clinical consulting providers to bill for their services.




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Anesthesiologists
BCHC participating anesthesiologists bill BCHC directly for their services.

Recruitment
BCHC outreach workers work in the community to recruit eligible women into BCHC
clinical services. Outreach workers make BCHC eligibility determinations and complete
BCHC Annual Enrollment forms in support of screening providers.




              Client Eligibility and Enrollment

Program eligibility is based on age, income and medical coverage.

Outreach and screening provider staff make all BCHC eligibility determinations based
upon the information they collect and record on the BCHC Annual Enrollment form.
Each woman’s BCHC Annual Enrollment form must be received by BCHC prior to
payment for her services.

The BCHC Annual Enrollment form is not complete until it has been signed by the
woman.

All BCHC clients are enrolled in BCHC for one year following the date the BCHC Annual
Enrollment form is signed.

Eligibility
Age
Women aged 18–64 may be eligible for enrollment into BCHC. Younger women may
be considered on a case by case basis and only when approved by BCHC clinical staff.
Federal regulations require that women aged 65 and older be encouraged to apply for
Medicare Part B.

Income
The upper limit of income eligibility is set at 250% of the Federal poverty level. Income
eligibility is determined by circling either the client’s monthly or yearly income on the grid
on the BCHC Annual Enrollment form. Women with incomes falling in the “more than”
columns on the grid are not eligible for BCHC, as their incomes exceed 250% of the
Federal poverty level.

Medical Coverage
The section on medical coverage on the BCHC Annual Enrollment form must be
completed by checking all boxes that apply. When a woman meets BCHC age and
income eligibility guidelines, she is eligible to be enrolled in BCHC unless she is
enrolled in Medicare Part B.




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Medical insurance coverage or a lack of medical coverage, does not affect BCHC
eligibility except for Medicare Part B. Women enrolled in Medicare Part B are not
eligible for BCHC.

Completion of the BCHC Annual Enrollment Form
A signed and completed BCHC Annual Enrollment form enrolls the woman into BCHC
for one year.

The BCHC Annual Enrollment form must have the following information recorded on it in
order to enroll the woman into BCHC:
   • Name of the screening clinic providing services;
   • Woman’s name and date of birth;
   • Woman’s household/family income circled;
   • Woman’s signature, which acknowledges her desire to participate in BCHC; and
   • Date the woman signed the form.

Outreach or screening provider staff should assure that each enrolled woman receives
the Client Information Handout attached to the BCHC Annual Enrollment form. The
Client Information Handout sheet explains that BCHC may not cover the cost of all
medical services recommended by the clinician and that clients may be responsible for
the cost of some services.

Eligibility determinations must be updated whenever a woman reports changes in
income or medical coverage.

Special Notes Regarding Enrollment of Insured Women
BCHC is the payer of last resort. Women who are age and income eligible for BCHC
and have insurance or TRICARE that pays for BCHC services at a rate greater than, or
equal to, the current Medicare rate may be enrolled in BCHC. These women will be
eligible for BCHC support for travel to receive clinical services that may be paid for by
their other health care coverage.

Outreach workers and screening providers must advise clients that their insurance or
TRICARE will be billed prior to billing BCHC. This is helpful for clients as services billed
to BCHC may be directly applied to the client’s annual deductible.

BCHC requires that clinical information needed to complete a diagnostic work up, or
initiate treatment, always be submitted regardless of who pays for the services. This
applies to BCHC enrolled clients having clinical services paid for by any other health
care coverage plans, including Medicaid. The client’s consent to enroll in BCHC
supplies consent for this information to be shared with BCHC under these conditions.




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             Delivery of Clinical Services

BCHC’s clinical guidelines describe current approaches to screening and diagnosis for
breast and cervical cancer and are appropriate for most BCHC clients. Clinicians may
exercise discretion in deviating from the clinical guidelines in order to address unusual
clinical, geographic, or personal circumstances.

BCHC encourages providers to carefully evaluate enrolled clients to ensure they receive
appropriate screening as described in the BCHC clinical guidelines. For women:
   • Age 18–39: Pap test beginning three years after the initiation of vaginal
     intercourse and then, for those without increased risk, every third year following
     three successive normal tests; clinical breast examination annually.
   • Age 40–49: For those at low risk, Pap test every third year following three
     successive normal tests; clinical breast examination annually, and, at clinician’s
     discretion, a screening mammogram.
   • Age 50–64: For those at low risk, Pap test every third year following three
     successive normal tests; clinical breast examination and screening mammogram
     annually.

Cervical Cancer Screening
Following three, consecutive, normal Pap tests within a 5-year (60 month) period, the
Pap tests may be performed every 3 years in low-risk women. BCHC discourages more
frequent Pap testing for low-risk women.

The clinician’s assessment as to the woman’s cervical cancer risk status shall be the
determining factor regarding the need for continuing annual Pap testing.

BCHC requires that all women with Pap smear results of ASC-H, HSIL, AGC, or
squamous cell carcinoma:
   1. Complete a diagnostic work up within 60 days of the date of the severe
      dysplasia or suspicious for cancer finding; and, when needed,
   2. Initiate treatment within 60 days of the date of any diagnosis of CIN II, III, or
      cancer.

Pap Smear after Hysterectomy
Cervical cancer screening in women after a hysterectomy is discouraged unless the
hysterectomy was done due to confirmed cervical neoplasia (cervical cancer or its
precursors). If a hysterectomy was done for reasons of cervical cancer, continued Pap
smear testing of the cervical cuff is recommended.




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Triage ASC-US Pap smear by HPV test
HPV testing utilizing the Hybrid Capture II (HCII) test from Digene Corporation is a
reimbursable laboratory procedure if used to direct the follow up of an unqualified ASC-
US Pap smear result from a screening examination. Only the high risk panel will be
reimbursed. HPV testing will not be reimbursed when done during the same office visit
as colposcopy or following any Pap result other than ASC-US.

Based on the recommendations included in the 2001 ASCCP Consensus Guidelines for
the Management of Women with Cervical Cytological Abnormalities, there are several
acceptable follow up scenarios for the clinical management of the ASC-US Pap smear
result, including monitoring cervical status by serial Pap smears at six month intervals.
Similarly, there are several acceptable scenarios in which the HPV test sample may be
collected when evaluation of ASC-US results are indicated, including:
    • Liquid based Pap specimen on first visit (with HPV test to be run from same
       sample as needed based on Pap result);
    • Conventional Pap smear on first visit with a subsequent brief office visit
       specifically for collection of HPV specimen when the Pap result is ASC-US; or
    • Conventional Pap smear and collection of a separate specimen for HPV test on
       first visit. The HPV specimen may then be retained either at the clinic or the lab
       and processed for HPV result if indicated based on a Pap result of ASC-US. In
       the event of any Pap result other than ASC-US, the specimen should be
       discarded.

Breast Cancer Screening
Optimal quality of breast screening occurs when the clinical breast examination is done
first, followed by a mammogram within 60 days.

BCHC requires that all women with suspicious for cancer CBE findings and/or
mammogram results BIRADS/ACR 4, 5, and 0 only when additional imaging is
recommended:
   1. Complete a diagnostic work up within 60 days of the date of the first
   suspicious or indeterminate finding; and, when needed
   2. Initiate treatment for cancer within 60 days of the date of the diagnosis of
   cancer.

Referring for Imaging or Clinical Consultation
BCHC covers the cost of approved imaging or clinical consultation services when
enrolled women receive those services from BCHC providers listed on the BCHC
Clinical Resources List. A current list may be obtained by contacting BCHC staff.

Imaging or clinical consultant providers set their own policies regarding protocols for
accepting clients referred to them for service. Referring clinical service providers must
work within those protocols and clearly indicate that the referred woman is a BCHC
client. When a client has medical coverage other than BCHC it is most helpful for that
information to be shared among all clinical providers involved in her care. Reminding




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clients to present their health insurance card at the time of each appointment helps
assure prompt processing of claims.

There are various methods and tools for ensuring that appropriate information is
conveyed to facilitate referrals within the program. Contact BCHC for more information.

Travel for Diagnostic Evaluation
When needed diagnostic services are not available in the client’s home community
BCHC will cover travel, room and board costs necessary to support client access to
services in another community where these are available from a BCHC provider.
Primary Contacts or Screening Provider staff make client travel arrangements by
contacting BCHC staff with detailed information about the travel need.

BCHC does not cover the cost of client travel for screening services outside of the
client’s home community.

Case Management
Case management services are intended to support women needing diagnostic work up
or treatment. BCHC screening providers must use a consistent method of assessing
client needs for case management. When case management support is needed, the
client and screening provider staff must develop a workable plan of care. A systematic
method of describing the client’s need for support and the plan of care to address those
needs must be documented in the client’s confidential medical record.

Primarily, case management is motivating communication between clients and their
care providers and actively coordinating client care among multiple clinical providers.

BCHC case management services may end when the:
  • Diagnostic work up is completed and the final results are benign;
  • Client and case manager determine that case management services are no
    longer necessary; and/or,
  • Treatment for a cervical dysplasia, or breast or cervical cancer has begun.

When a client refuses to complete her diagnostic work up or to initiate treatment
recommended by a BCHC provider, screening provider staff must document the
following in the client’s medical record:
    • The date of the client’s refusal;
    • Any reason the client may give for refusing; and
    • The nature of the information shared with the client by the provider including, in
       lay terms, expected benefits of clinical care and potential poor outcomes if the
       recommended clinical care is not obtained in a timely manner.

Referring Clients for Treatment Coverage
BCHC staff follow a standard process for referring clients to Medicaid for treatment
coverage. Only clients referred by BCHC may apply using this process. Upon receipt
of a report of breast or cervical cancer, CIN II or CIN III in a BCHC enrolled client,



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BCHC staff generate a referral to the Division of Public Assistance (DPA) for the client’s
application to Medicaid. BCHC staff mail the Medicaid application directly to the client
using the address on the BCHC Annual Enrollment form. Incorrect client address
may delay the client’s receipt of her mailed packet as well as timely access to
treatment. Each mailing includes a pre-addressed envelope so that clients can mail
their completed application directly to DPA. Clients having questions about the
application process may call DPA in Anchorage at 269-8978. DPA accepts long
distance collect calls from BCHC applicants calling from outside the Anchorage area.

BCHC staff notify the screening provider of the referral in writing. A copy of this referral
may be retained in the client’s medical record.

Application to Medicaid does not guarantee enrollment or coverage. DPA makes
all eligibility determinations for Medicaid.

Women enrolled in Medicaid pay a small co-pay.

The Centers for Medicare and Medicaid Services (CMS), which sets and monitors policy
and regulation for Medicare and Medicaid at the federal level, has issued the following
clarifying statement regarding treatment for BCHC women enrolled in Medicaid: “The
term ‘needs treatment’ means, in the opinion of the client’s treating health professional
that the diagnostic test following a breast or cervical cancer screen indicates that the
client is in need of cancer treatment services. These services include diagnostic
services that may be necessary to determine the extent and proper course of treatment,
as well as definitive cancer treatment itself. Based on the physician’s care plan, clients
who are determined to require only routine monitoring services for a pre-cancerous
breast or cervical condition (e.g., breast examinations and mammograms) are not
considered to need treatment.”

BCHC interprets this to mean that clients with biopsy results of CIN II or III, and CIN I
when recommended for treatment, may apply for treatment funding even though they
have not been diagnosed with cervical cancer.

BCHC providers may contact BCHC clinical staff with questions related to diagnosis and
treatment.

Requirements for Tracking Clients for Follow Up
The BCHC Primary Contact, or other screening provider staff, are required to maintain
and utilize a tickler system for tracking and recall of clients. Ideally, the same tickler
system may be used to track women for:
   • Follow up on progress of diagnostic work ups;
   • Re-call for repeat Pap testing or repeat CBE; and
   • Annual re-screening according to the schedules outlined in the BCHC clinical
      guidelines.




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Provider computer tracking systems or manual ticklers are ideal for this purpose.
During on site QA review visits BCHC QA staff evaluate provider tracking systems and
procedures for their use.

Notifying Clients of Clinical Results
Clinical providers are expected to notify clients of abnormal clinical results as soon as
possible and no later than seven business days following the date when results are
received. Clients failing to respond to two telephone or regular mail notification
attempts regarding their need for clinical care must receive a third and final notification
attempt made by certified mail. A certified mail receipt and a copy of the notice sent
must be retained in the medical record as documentation of the notice effort made. The
certified mail letter must include, in lay terms, expected benefits of care and potential
poor outcomes if the recommended care is not obtained in a timely manner.

Clinical providers are required to notify clients of normal clinical results within three
weeks following the date the result is received.

Documentation of notification of results must be recorded in the client’s medical record.
This must include:
   • Date the client was notified;
   • Method of notification (in person, by phone or mail);
   • Specific information shared;
   • Re-screening or follow-up recommendation made; and
   • Signature of the staff person making the notation.

BCHC offers a self-inking stamp to be used to imprint prompts for recording all the
required documentation in medical records. Providers may request this tool from BCHC
staff.

Contacting Clients for Re-Screening
BCHC expects that two contact efforts will be made to recall the client to re-screening.
If the client schedules an appointment which she later fails to keep, one additional
contact effort is expected. Contacts may be made by phone or mail. Contact attempts
and missed appointments are to be documented in the client’s medical record.

Special Note Regarding Data Collection Forms
BCHC clinical data collection forms are not intended for use as a client medical record,
but are intended for data submission purposes only. These forms may be retained until
the provider assures that BCHC has received them, but retention for any length of time
beyond that is unnecessary. BCHC clinical data collection forms are intended solely for
the purpose of facilitating communication about information required by BCHC.




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             Submitting Client Information to BCHC


As a condition of its funding, BCHC is required to submit to CDC breast and cervical
cancer screening, diagnostic and treatment information about all enrolled women.
Information submitted to CDC does not include names, social security or chart numbers.
Information may be submitted to BCHC on data collection forms, clinical notes,
cytology, imaging, and biopsy reports.

BCHC requires submission of the following:
  • Information about BCHC covered services corresponding to those billed;
  • Limited information about breast and cervical cancer screening and disease
     history;
  • Information necessary to support initiating or completing a diagnostic work up,
     regardless of payer for those services;
  • The date treatment is started;
  • The date a client refused diagnostic work up or treatment; or
  • The date a client is known to be lost to follow up prior to completion of her
     diagnostic work up or starting treatment.

Clinical providers may share laboratory reports with BCHC by indicating on the
requisition that BCHC is to receive a courtesy copy. Imaging centers generally submit
reports generated by their facilities directly to BCHC. Occasionally, providers may be
asked to submit breast and cervical clinical information to BCHC even when BCHC did
not cover the cost of those services. BCHC limits these requests to information
specifically needed to fulfill CDC reporting requirements.

BCHC periodically requests clarification of data previously received or requests data
needed from clinical providers. Various reports are used to request clinical information.




             Reimbursement and Billing

BCHC pays for approved breast and cervical cancer screening and diagnostic services.
BCHC pays approved services at the Medicare rate. Program approved services, and
the rates at which they are paid, are detailed on the BCHC Listing of Approved CPT
Codes. This document is available at BCHC’s website at:
hss.state.ak.us/dph/wcfh/bchc/provider/pro_become.htm or by request. Providers will




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not be reimbursed more than the amount billed, even if that is less than the Medicare
rate.

Clients provided services through BCHC may not be charged on a sliding fee scale,
billed for deductibles, co-pay, bill balances or administrative fees for any program
covered services while they are enrolled in BCHC. Providers may not ask women to
pay for BCHC services even when the provider is planning to reimburse them.

Submit claims to BCHC to the address at the end of this guide.

Claims are paid when:
   • The provider has a current BCHC Provider Agreement on file with BCHC;
   • The client’s signed BCHC Annual Enrollment form is on file with BCHC;
   • The service date is within the enrollment period (one year beginning on the date
     of the enrollment);
   • Clinical information corresponding to the service being billed is on file with BCHC;
   • The service billed is an approved BCHC CPT code;
   • The service was for appropriate breast or cervical screening and/or diagnosis per
     the BCHC clinical guidelines and any relevant conditions described in the BCHC
     Listing of Approved CPT Codes; and
   • If the woman has other health care coverage, disposition information (EOB) is on
     file with BCHC (see Other Health Care Coverage below).

State of Alaska warrants are issued to pay services approved by BCHC. These
warrants are sent to the billing provider, along with a Remittance Advice (RA) report for
each warrant. The RA lists each claim paid via the warrant, and lists for each claim:
    • The amount billed;
    • The amount paid by other coverage (if any);
    • The amount BCHC was able to pay; and
    • The amount BCHC was not able to pay.
If BCHC is not able to pay the full amount billed, the RA also explains the reasons why.

Sometimes BCHC is not able to pay anything on a claim. These claims are reported
back to the billing provider as well, on reports that explain why BCHC is not able to pay.

Providers may not bill BCHC enrolled women for the difference between their usual and
customary charges and the amount paid by BCHC. This amount must be written off.
Providers may not bill BCHC enrolled women for the difference between their usual and
customary charges and the amount paid by the primary payer if the woman has other
health care coverage. This amount must also be written off. These write off policies
apply only to BCHC covered services.

BCHC does not pay for:
  • Office visits or consultation fees associated with procedures not covered by the
    program (for example, pre-natal care);
  • Inpatient hospital stays, including supplies and inpatient care charges;



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    • Travel outside of the client’s community of residence for screening services;
    • Treatment, or travel for treatment services.

Claims for screening mammograms for BCHC enrolled women aged 40-49 should be
submitted directly to BCHC. The Alaska Run for Women (ARW) raises money to cover
the cost of mammograms for this group of women. ARW, the YWCA of Anchorage and
BCHC have arranged for a seamless process for paying claims for these
mammograms. BCHC processes submitted claims, then routes them to the YWCA of
Anchorage for payment from ARW funds. Providers then receive checks written by the
YWCA along with standard Remittance Advice reports from BCHC.

Other Health Care Coverage
BCHC is the payer of last resort. BCHC cannot complete processing of claims for
clients with other health care coverage until an Explanation of Benefits (EOB) from that
other payment source has been received. Claims for clients with other health care
coverage will pend until the EOB is received by BCHC.

BCHC will pay the difference between the amount paid by a client’s other health care
coverage and the Medicare rate for that CPT code.

Every BCHC client should receive a copy of her statement showing what services have
been billed and to which payment source bills have been submitted. Clients with other
health care coverage may submit their statements showing EOB information directly to
BCHC. Alternatively, screening providers may provide secondary coverage billing
services by submitting claims and EOBs to BCHC. BCHC will not bill another payer
source.

Reports Regarding Pended Claims
As noted above, BCHC requires certain information in order to process claims. Claims
received by BCHC will pend until all the information is received necessary to determine
whether BCHC can pay. Screening, imaging and clinical consultant providers receive
reports from BCHC indicating information necessary to process claims. These reports
are produced and sent monthly.

The BCHC Report on Enrollment Problems and Pended Claims lists claims that BCHC
is unable to process due to missing clinical or enrollment information. A provider
receiving this report should be in possession of all the information indicated as needed
by BCHC for claim processing, and should be able to forward the relevant information to
BCHC. If there is any question as to the information BCHC requires, contact BCHC.

Billing offices are sent the BCHC Report on Claims Pended for EOB. This report shows
claims pended because BCHC understands the client has other medical coverage, and
BCHC has not received an EOB. This report also lists the other payer, if known to
BCHC. This report is mainly for informational purposes as to claim status.




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Special Fees Paid to Screening Providers
Because BCHC screening providers deliver a number of required services to BCHC
clients, BCHC supports this work by paying screening providers a special client
management fee. BCHC also pays screening providers a bonus fee for each client
aged 50–64 who receives a mammogram within 60 days following her CBE. These fee
amounts are based on availability of program resources.

Fee payments are computed quarterly and paid to screening providers for each woman:
   • Who received BCHC services; and
   • For whom the screening provider has not been paid this fee within the past year.
Payments are via state warrant, with the relevant clients noted on a BCHC Remittance
Advice report.




              Recruitment: Inreach & Outreach

BCHC clinical providers may use opportunities during client check in or check out to
advise women of the benefits of BCHC. BCHC clinical staff are available to assist
screening providers with strategies to ensure that BCHC eligible clients in their practice
are offered BCHC coverage. Marketing materials suitable for clinic environments may
be ordered by contacting BCHC staff.

BCHC funds outreach projects in some communities. Outreach projects are designed
to increase the number of women screened in BCHC, especially women who:
    • Are 50–64 years of age;
    • Have never been screened, or have not been screened in 5 or more years; or
    • Are part of a priority population, including African American, Latina, Asian, Pacific
       Islander, lesbian, Alaska Native or those recently immigrated.

Outreach projects work with BCHC screening providers to track women and encourage
them to access clinical services, including mammography for those aged 50–64.

BCHC’s toll free 1-800-410-6266 line allows women and providers from anywhere in
Alaska to access:
   • Clinics offering CDC funded Breast and Cervical Cancer Screening Services;
   • The Cancer Information Service,
   • Cancer Care, an organization providing many services for patients diagnosed with
     cancer; and
   • BCHC staff.




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             Quality Assurance and Quality Improvement

BCHC quality assurance monitoring and improvement entail the use of established
standards, policies, and procedures which assess and identify practical methods for
improving delivery and overall quality of program services.

BCHC quality assurance staff systematically collect, compile and analyze program data
in order to evaluate the quality and appropriateness of all aspects of service delivery.

BCHC quality assurance staff evaluate service delivery using program data with a mind
to assure that clients:
    • Aged 18–64 receive mammograms within 60 days of screening examination;
    • With CBE results suspicious for cancer, or mammogram results of BIRADS 4,5,or
      0 when there are no final results, and those with Pap test results read as ASC-H,
      HSIL, AGC, or squamous cell carcinoma complete work-ups within 60 days;
    • Diagnosed with cancer initiate treatment within 60 days of the date of diagnosis;
      and
    • For individuals at low risk for cervical cancer and those having had a
      hysterectomy for any reason other than cervical neoplasia (cervical cancer or its
      precursors), the Pap test will not be over used.

Periodic on-site visits with providers are conducted by BCHC quality assurance staff.
These reviews may be conducted at the discretion of BCHC to ensure compliance with
program service delivery standards, or at the request of providers. Medical records
review, client tracking and re-call systems and protocols, documentation and case
management efforts are always evaluated. Site visit dates and schedules are always by
appointment and are always negotiated with providers in advance.

Each BCHC staff member is bound to uphold a strict confidentiality agreement that
protects the client from the unauthorized release of any sensitive personal health
information. Staff are also aware of the need to protect providers from the inappropriate
release of sensitive information about them or their clinical practices.




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              Contacting BCHC


Mailing address:     State of Alaska
                     Department of Health and Social Services
                     Division of Public Health
                     BCHC
                     PO Box 240249, Suite 978
                     Anchorage, AK 99524-0249



Confidential fax line:      907-269-3414

Toll free telephone line:   1-800-410-6266

Website address:            hss.state.ak.us/dph/wcfh/BCHC

BCHC email address:         health_check@health.state.ak.us



For assistance with:
    • Reimbursement and Billing,
    • Ordering printed materials and other program supplies, or
    • Client travel
call 269-4662 or 1-800-410-6266, #3.

For assistance with:
    • Delivery of Clinical Services, including diagnostic and treatment information; or
    • Inreach and Outreach
call 269-8077

For assistance with:
    • Administrative issues
call 269-3491




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