Download a printable version to read or shareDecember 2019
|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.|
Welcome to the first edition of Blues Brief for Behavioral Health providers
This special issue of Blues Brief is designed to cover topics of interest just for you. It will be published at least once per year. For more frequent news from us, you can subscribe to our monthly edition of Blues Brief for professional providers or quarterly edition for hospitals and facilities. These publications, along with the BCN Provider News and The Record newsletters, are 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.
How to request prior authorization for State of Michigan enrollees
New Directions Behavioral Health will manage behavioral health and substance use disorder benefits on behalf of Blue Cross Blue Shield of Michigan for State of Michigan enrollees (group number 007000562), effective Oct. 1, 2019.
These benefits were previously managed by Magellan Health. This change affects services provided on or after Oct. 1, 2019. Read more in the September 2019 issue of The Record.
Online visits available to MPSERS members with Medicare Plus Blue starting in January
Beginning Jan. 1, 2020, our Medicare Plus BlueSM PPO plan will offer Blue Cross Online VisitsSM to Michigan Public School Employee Retirement System group members. Members who use this benefit can virtually connect with a physician, therapist or other health care provider using a smartphone, tablet, computer with a web camera or video conferencing device. Read more in the November 2019 issue of The Record.
We’re using updated utilization management criteria for behavioral health
On Aug. 1, 2019, Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM plans began using the 2019 InterQual® criteria for behavioral health utilization management determinations. In addition, certain types of determinations are now based on modifications to InterQual criteria or on local rules or medical policies.
Encourage follow-up care for mental health, substance use disorder after a patient visits ER
In the United States, 18% of adults and 13% to 20% of children experience mental illness, according to the National Committee for Quality Assurance.
Follow-up care for mental health issues is crucial. It helps to:
Read more in the November 2019 issue of The Record.
Board-certified behavior analysts will need to be licensed to be eligible for reimbursement
Starting Jan. 7, 2020, board-certified behavior analysts practicing in Michigan must be licensed by the State of Michigan to be eligible for reimbursement from Blue Cross and BCN. Board-certified behavior analysts who aren’t licensed aren’t eligible for reimbursement for services provided on or after Jan. 7, 2020.
For more information, see Page 23 of the September–October 2019 BCN Provider News or the September 2019 issue of The Record.
Concurrent billing is allowed for some ABA procedure codes for commercial members
Board-certified behavior analysts can bill for services provided to the same client by two providers at the same time for the following applied behavior analysis procedure codes. This was effective Sept. 1, 2019:
This applies to Blue Cross’ PPO (commercial) and BCN HMOSM (commercial) members.
For more information, see Page 21 of the November–December 2019 BCN Provider News or the November 2019 issue of The Record.
Reminder: Blue Cross and BCN now accepting applied behavior analysis claims with 2019 procedure codes
Blue Cross and BCN began accepting claims for behavior analysis services billed with the following codes, for dates of service on or after June 1, 2019: *97151, *97152, *97153, *97154, *97155, *97156, *97157, *97158, *0362T and *0373T.
Claims billed with the following codes will still be honored: H0031, H0032, H2019, H2014, S5108 and S5111.
For more information, see Page 17 of the November–December 2019 BCN Provider News or the July 2019 issue of The Record.
Changes to reimbursement policy for board-certified behavior analysts take place Jan. 1
Effective Jan. 1, 2020, the following two reimbursement policy changes affecting board-certified behavior analysts will occur.
Read more in the October 2019 issue of The Record.
Holiday office closings
Blue Cross and BCN offices will be closed Dec. 24 through 25 (Christmas) and Dec. 31 through Jan. 1.
*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association.