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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. Blue Cross and BCN offer several diabetes prevention and management programs More than 30 million people have diabetes. That’s one in 10 individuals — and one of four don’t know they have it. Blue Cross Blue Shield of Michigan and Blue Care Network are working to help members who currently have diabetes or are at risk of getting it. Read about our available programs on Page 10 of the March–April 2019 BCN Provider News or the February 2019 issue of The Record. Commercial pharmacy audits begin in April Blue Cross is using SCIO Health Analytics to conduct compliance audits on 2018 pharmacy claims. The audits will be claim-specifi c and help ensure that paid claims were accurately billed according to Blue Cross and BCN pharmacy guidelines, as well as state and federal laws. Pharmacies are required to comply with audit requests from Blue Cross, BCN or its agents according to the terms and conditions of the pharmacy network participation agreement. For more information, see the April 2019 issue of The Record. Additional changes to BCN process for requesting peer-to-peer review of non-behavioral health cases We’ve made additional changes to the process of asking for a peer-to-peer review of a denied authorization of a non-behavioral health service for BCN HMOSM (commercial) or BCN AdvantageSM members. We have outlined these requirements in Section 1 of the How to request a peer-to-peer review with a BCN medical director document. You will also find instructions on requesting a peer-to-peer review with a BCN medical director about services for which an authorization request has been denied in this document. 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 Holiday office closings Blue Cross and BCN offi ces will be closed April 19 (Good Friday). e-referral updates
The User Guides have been updated regarding these changes. You can find these on the Training Tools page of ereferrals.bcbsm.com. Blue Cross changing practitioner fees July 1 BCBSM will change practitioner fees with dates of service on or after July 1, 2019. This change applies to services provided to our Traditional, TRUST and Blue Preferred Plus members, regardless of customer group. The new fee schedules will be available April 1 on web-DENIS; however, only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates. For more information, see the April 2019 issue of The Record. New Medicare Plus Blue PPO reimbursement policies coming July 1 Effective July 01, 2019, Medicare Plus Blue PPO will implement new reimbursement policies for the following claims billed with HCPCS or CPT codes that don’t have an assigned Medicare fee:
For more information, see the April 2019 issue of The Record. Medicare Advantage Provider Office Laboratory List updates The Medicare Advantage POLL is being updated to reflect changes in CPT coding. The procedures on the list are those that we believe are appropriate to be provided in an offi ce setting. If you provide lab services that aren’t on this list, you won’t be paid. There are 69 codes payable from a provider’s office that are being added. Two codes (*80306 and *80307) were effective for claims submitted with dates of service on or after Jan. 1, 2017, and the remainder will be effective for claims submitted with dates of service on or after April 1, 2019. For more information as well as a link to the updated code list, see the April 2019 issue of The Record. *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved. National Prescription Drug Take Back Day scheduled for April 27 Let your patients know that the next National Prescription Drug Take Back Day is scheduled for April 27 from 10 a.m. to 2 p.m. These twice-yearly events, coordinated by the U.S. Drug Enforcement Administration, provide a safe, convenient and responsible means of disposing of prescription drugs, while also educating the public about the potential for abuse of medications. For more information, refer to the April 2019 issue of The Record. Medicare Plus Blue PPO inpatient admission appeals process All Michigan health care providers have the right to appeal an adverse medical decision made by BCBSM’s Medicare Plus Blue Utilization Management department. For more information about requesting and appeal, submitting first- and second-levels appeals, and appeal timeframes, refer to the Medicare Plus Blue PPO Provider Manual, as well as the April 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. |