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This newsletter includes short summaries, reminders and updates for Blue Cross and BCN providers. Please visit The Record or BCN Provider News for complete newsletter editions. Reminder: New clinical editing system changes Although we’ve delayed our upgrade to a new clinical editing system — from ClaimCheck to ClaimsXten — we want to remind you about key changes. Please see the explanation of changes with new explanation codes and the clinical editing form on Page 27 of the March–April 2019 BCN Provider News. Complete new questionnaires in e-referral for BCN members New questionnaires are open for Blue Care Network authorization requests in the e-referral system for the following outpatient procedures:
In addition, updated or new questionnaires for the following services opened for BCN authorization requests in the e-referral system on Nov. 25, 2018:
We’ve made preview questionnaires available at ereferrals.bcbsm.com. To find them, click BCN,
then click Authorization Requirements & Criteria. Next, look in the For more information, see Page 31 of the March–April 2019 BCN Provider News. Sign up to receive Blues Brief electronically As announced previously, Blues Brief has a new look and is now available via email subscription. To sign up and avoid possible subscription errors, add Blues Brief to your subscriptions by clicking the Manage Subscriptions link at the bottom of your BCN Provider News or The Record newsletter emails. You can also visit the subscription page on bcbsm.com/providers to choose your preferred Blues Brief versions. Read more on Page 6 of the March–April 2019 BCN Provider News or the March 2019 issue of The Record. RA Limited Choice program gets new name — CA Limited Choice Blue Cross Blue Shield of Michigan and BCN are renaming their Religious Accommodation Limited Choice program. It will now be called the Contraceptive Accommodation Limited Choice, or CA Limited Choice, program. Members who enroll in the program on or after Jan. 14, 2019, will receive new ID cards. Members who are already enrolled may continue to use their RA Limited Choice ID cards. Blue Cross and BCN members must use either their CA Limited Choice ID card or their RA Limited Choice ID card to obtain contraceptive services at no cost share from a network provider. For more information, see Page 6 of the March–April 2019 BCN Provider News or the February 2019 issueof The Record. Holiday office closings Blue Cross and BCN offi ces will be closed April 19 (Good Friday) and May 27 (Memorial Day). Certain infusion drugs won’t be covered in outpatient hospitals, starting April 1 Beginning April 1, 2019, Blue Cross is adding six pre-authorized medical drugs to the site of care requirement for members. Infusions for these drugs won’t be covered at hospital outpatient facilities without prior authorization for an approved location, starting April 1. For more information, see the March 2019 issue of The Record. Here’s our hospital transfer policy We’d like to remind you of Blue Cross' policy on transferring a patient from one hospital to another. When patients are discharged or transferred to another hospital, please indicate the appropriate discharge disposition as follows:
Blue Cross reviews paid claims to identify patients who were discharged or transferred to another acute care facility. If we identify claims that should have been billed as transfers, we’ll adjust your payment. For more details, see the March 2019 issue of The Record. Requirements for providing behavioral health services to Blue Cross PPO (commercial) members flyer now available This flyer provides brief behavioral health billing guidelines by provider type and practice setting. You can find the flyer at ereferrals.bcbsm.com, then click Blue Cross, then click Behavioral Health. Next, look in the Commercial home health service claims audit underway In February, SCIO Health Analytics®, an independent company working for Blue Cross, began auditing claims for commercial home health services. SCIO is conducting these audits to ensure that your billed and paid services over the past 18 months were ordered, medically necessary, documented, reported and covered under the patient’s contract, according to Blue Cross policies and guidelines. If you’re a home health care provider, be ready to share medical charts for review. For more information, see the March 2019 issue of The Record. We invite you to join PGIP as an organized system of care Blue Cross encourages our participating network physicians and organized systems of care to get involved in the Physician Group Incentive Program. PGIP has been improving the quality and effi ciency of health care in Michigan for more than 12 years. That’s why we’re pleased to announce that we’ll accept applications from new OSCs from April 1 through April 30, 2019. OSCs that apply before the April 30 deadline and are accepted into the program will be eligible to participate in PGIP’s new PPO risk program for OSCs, starting in 2020. For more information, see the March 2019 issue of The Record. |
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |