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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. Sign up for additional training webinars Provider Experience is continuing its series of training webinars for health care providers and staff. The webinars were designed to help you work more efficiently with Blue Cross Blue Shield of Michigan and Blue Care Network.
Blues 201 provides in-depth learning opportunities for providers and builds on information shared in our Blues 101: Understanding the Basics webinar. We’ll add more vaccines to pharmacy benefit Aug. 1 Starting Aug. 1, 2019, eligible Blue Cross and BCN commercial non-Medicare members will have coverage for additional vaccines under their pharmacy benefits plan. This allows participating pharmacies to bill through the pharmacy claims processing system. We’ve added the following vaccines to the pharmacy benefit:
For more details, see the August 2019 issue of The Record. HEDIS measure tip sheets updated for 2019 As part of our ongoing collaborative efforts with our participating physicians to improve health care quality, we’ve updated our HEDIS® measure tip sheets for 2019. The tip sheets highlight specific measures that are included in the Healthcare Effectiveness and Data Information Set, commonly called HEDIS. The tip sheets can be found on web-DENIS. Click on BCBSM Provider Publications and Resources or BCN Provider Publications and Resources then Clinical Quality Corner. For more information, see the August 2019 issue of The Record. HEDIS® is a registered trademark of the National Committee for Quality Assurance. Blue Cross launches value-based incentive program Blueprint for Affordability Blue Cross has been at the forefront of finding ways to help our members and customers save money while still providing access to quality care. In the coming years, Blue Cross will work with all stakeholders to address our customer and member concerns with the rising cost of care. This effort is called the Blueprint for Affordability. This program was highlighted in the July–August 2019 Hospital and Physician Update. Stay tuned for more information on this program. Reminder: Use in-network laboratories A regular review of our claims data shows that a number of providers are using noncontracted laboratories for Blue Cross and BCN patients. Going out of network for lab services may cause unnecessary expenses. Read more on Page 6 of the July–August 2019 BCN Provider News. Blue Cross, BCN offering innovative insulin management program to qualifying members Blue Cross and BCN are offering the d-Nav® Insulin Guidance Service to patients who have Type 2 diabetes. We’re the first U.S. health plans to offer this service, which was recently featured by the American Diabetes Association on ADA TV* and in The Lancet*. Participants receive the d-Nav® Phone App, which was approved by the U.S. Food and Drug Administration, and a connected glucose meter. The d-Nav app provides insulin dose recommendations prior to each injection of insulin. For more information, see the August 2019 issue of The Record. *Blue Cross Blue Shield of Michigan and Blue Care Network don't own or control this website. We’re changing categorization process for physical therapy Beginning in January 2020, physical therapists will be assigned to one category — A, B or C — for all four networks: Blue Cross Blue Shield of Michigan, Medicare Plus BlueSM, Blue Care Network and BCN AdvantageSM. Categories are based on the physical therapy paid claims data for all four networks. Due to the upcoming changes in the categorization process, you won’t be receiving profile reports that were originally scheduled for July 2019 for Blue Cross and for November 2019 for BCN. You’ll maintain your current provider categories and current program requirements until the new combined categories are sent by eviCore healthcare, an independent company, in February 2020. For more details, see the August 2019 issue of The Record. Reminder: Providing services to patients in an out-of-state MA PPO plan We want to remind our health care providers about Medicare Advantage PPO network sharing for Blue Cross Blue Shield plans. Network sharing allows patients to see any Medicare Advantage PPO provider across the country and obtain in-network benefits. If you’re a Blue Cross Blue Shield of Michigan contracted MA PPO provider and see a Medicare Advantage PPO member from another Blue plan, they’ll have the same access to care as a Blue Cross Blue Shield of Michigan member. If you’re not contracted with Blue Cross Blue Shield of Michigan for our MA PPO plan and you provide services for any Blue Medicare Advantage member, you’ll receive the Medicare-allowed amount for covered services. For more information about checking for coverage and benefits, see the August 2019 issue of The Record. Save the date: You’re invited to a Stars Premiere event near you This year, Blue Cross’ Quality and Provider Education team and Customer Experience team are holding a special production called the Stars Premiere in theaters around the state. This event will include information about the Medicare Star Rating System, HEDIS measures, the Health Outcomes Survey and much more. When you attend, you can earn Continuing Education Unit credits and participate in a highly engaging 90 minutes of conversation and activities. For dates, locations and a schedule of events, see the August 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. |