Redesigned Blues Brief available electronically
Blues Brief has a new look, and now you can subscribe to it electronically. Visit bcbsm.com/providers, click Our Provider Newsletters and then the green Subscribe button. Read more on Page 7 of the January–February 2019 BCN Provider News or the January 2019 issue of The Record.
Don’t issue referrals for members staying in-network
Beginning in March 2019, if you try to submit a global referral for a BCN AdvantageSM member in the e-referral system, you’ll receive a message indicating that the global referral cannot be accepted and therefore shouldn’t be submitted. Read more on Page 1 of the January – February 2019 BCN Provider News.
BCN Advantage lowers premiums and enriches benefits for 2019
Premiums are lower for five of our eight BCN Advantage products in 2019. We still have two $0 premium plans. We did have to raise the rate slightly on our MyChoice Wellness partnered product that is available in four western Michigan counties. Read more on Page 10 of the November–December 2018 BCN Provider News.
Behavioral Health Incentive Program continues in 2019
The BHIP offers broad-based suggestions for implementing practices shown to improve the well-being of patients and to reward those initiatives. The BHIP booklet and flyer will be available on web-DENIS starting in January. Read more on Page 20 of the January–February 2019 BCN Provider News.
2019 understanding member ID cards brochures available
The Understanding member ID cards brochure showcases the different ID cards you may see from members with Blue Cross or BCN coverage. It also includes the product names, prefixes and product details.
These brochures can be found on the BCN Provider Publications and Resources web-DENIS page under BCN Products or the BCBSM Newsletters and Resources page under Products and Networks. Read more on Page 5 of the January–February 2019 BCN Provider News.
These brochures can be found on the BCN Provider Publications and Resources web-DENIS page under BCN Products or the BCBSM Newsletters and Resources page under Products and Networks. Read more on Page 5 of the January–February 2019 BCN Provider News.
Health e-BlueSM data entry due soon
The deadline for submitting electronic medical record files is Feb. 8, 2019.
Pharmacy updates
Pharmacy Prior Authorization Help Desk has new user-friendly prompts
See the October 2018 issue of The Record.
AllianceRx Walgreens Prime specialty pharmacy program starts Jan. 1
See Page 29 of the January–February 2019 BCN Provider News or the November 2018 issue of The Record.
ESI to be Michigan retail pharmacy network manager for our commercial business, starting Jan. 1
See the December 2018 issue of The Record.
e-referral now includes updated authorization criteria and questionnaires
We’ve made updates to the authorization criteria and questionnaires in the e-referral system for several procedures. We use these criteria and questionnaires when making utilization management determinations for BCN HMO, BCN Advantage, and Blue Cross Medicare Plus Blue PPO members.
For more information, see Page 38 of the January–February 2019 BCN Provider News or the December 2018 issue of The Record.
GM to offer new plan option — ConnectedCare: Henry Ford Health System
Effective Jan. 1, General Motors will offer a new PPO medical plan option for select salaried employees and eligible dependents in the Detroit area called ConnectedCare: Henry Ford Health System (group number 83640). This plan option is not affiliated with BCN AdvantageSM HMO ConnectedCare.
Blue Cross will serve as the third-party administrator of benefits for this plan option. As always, you can check web-DENIS for patient benefit and eligibility information.
For more plan information, see the December 2018 issue of The Record.
Change to prior authorization requirement
In an October 2018 issue of The Record, we told you that you’d need to obtain prior authorization for high-tech radiology, in-lab sleep management and echocardiogram services for all Blue Cross Blue Shield of Michigan PPO members, regardless of where they lived. We’ve subsequently changed our approach and will only require prior authorization for those services for patients who live in Michigan.
AMA updates applied behavior analysis codes for autism
The following T codes used to bill applied behavior analysis for autism services to Blue Cross will be replaced starting Jan. 1, 2019: *0359T-*0361T, *0363T-*0372T, *0374T.
Prior authorizations for applied behavior analysis that were requested and approved under the T codes will remain valid. You don’t need to request a new authorization to accommodate the change in procedure codes.
For more information, see the January 2019 issue of The Record.
New for 2019: FEP Blue Focus
The Blue Cross and Blue Shield Federal Employee Program® has a new benefit option for 2019, FEP Blue Focus. This is a fee-for-service plan that provides covered services through a PPO. Members can choose their own health care providers without referrals but must use preferred providers to receive benefits.
For more information, see the January 2019 issue of The Record.
