Update on the Oncology Value Management program through OncoHealth

As we reported in the October 2024 Record, OncoHealth^® will manage prior authorizations for medical benefit oncology and supportive care drugs for most members through the Oncology Value Management program. This applies to dates of service on or after Jan. 1, 2025.

Here’s some additional information about this change.

Enhanced reimbursement is ending

Starting Jan. 1, 2025, the Oncology Value Management program will no longer offer providers enhanced reimbursement for medical oncology services billed with HCPCS codes S0353 and S0354.

Note: The enhanced reimbursement will continue to be available for Blue Cross Blue Shield of Michigan UAW Retiree Medical Benefits Trust non-Medicare members because Carelon will continue to manage prior authorizations for medical benefit oncology drugs for these members.

How to submit retroactive authorization requests, starting Jan. 1

Starting Jan. 1, 2025, submit retroactive authorization requests with dates of service on or before Dec. 31, 2024, to OncoHealth.

Register for a live webinar

To register for a webinar, see the Register for a live webinar about the Oncology Value Management program through OncoHealth article in this issue.

Watch for additional provider alerts and newsletter articles about this change.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services. For more information, go to our ereferrals.bcbsm.com website.

OncoHealth is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing cancer support services.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.