New oncology management program for BCN starting Aug. 1

The Oncology Management Program promotes optimal cancer care and allows providers to compare planned cancer treatment against evidence-based regimens. The program will require providers to obtain authorizations from AIM Specialty Health^® for medical oncology and supportive chemotherapy drugs, as well as immunotherapy. AIM applies Blue Cross Blue Shield of Michigan and Blue Care Network medical policies and identifi es a subset of regimens as a Cancer Treatment Pathway. Blue Cross and BCN medical policies support Food and Drug Administration labeled indications and/or the National Comprehensive Cancer Network guidelines.

To learn more:

• Join a webinar to learn about this new program and how to use the AIM ProviderPortal (see Page 26 of the May–June 2019 BCN Provider News).
• Visit the AIM Specialty Health website.
• See the medical oncology drug lists for BCN HMO or URMBT on ereferrals.bcbsm.com. Click BCN or Blue Cross then AIM-Managed Procedures under the Authorizations / Referrals section.

Find billing help on our website

We offer billing resources within Provider Secured Services. Just log in to Provider Secured Services and click BCN Provider Publications and Resources. Then click Billing/Claims.

On the Billing/Claims page you’ll find:

• The BCN Provider Manual Claims chapter
• General information, including claims troubleshooting tips
• Clinical editing resources, including archived clinical editing billing tips from BCN Provider News
• Professional Claims - Billing Instructions
• We've updated the billing information for Healthy Blue Living^SM visits and forms.
• Facility Claims - Billing Instructions
• An FAQ document was added about billing for rural health clinics, federally qualified health centers and critical access hospitals for BCN Advantage members. Click RHCs, FQHCs and CAHs.

If you have an urgent question and can’t find the answer on our website, call Provider Inquiry. Professional providers phone 1-800-344-8525; ancillary and facility providers phone 1-800-249-5103. See this information on Page 30 of the May – June 2019 BCN Provider News.

Reminder: Submit BCN authorization requests for all therapy and physical medicine visits to eviCore

As a reminder, eviCore healthcare now manages all authorization requests for outpatient physical, occupational and speech therapy by therapists and physical medicine services by chiropractors. See this information on Page 35 of the May–June 2019 BCN Provider News.

Provider Secured Services reminder: use your company email for access requests

We’d like to connect your online account to an email address that’s related to your business rather than a public email provider such as Hotmail, Gmail or Yahoo to protect your member’s information and keep your account secure. For more information, see Page 4 of the May–June 2019 BCN Provider News or the May 2019 issue of The Record.

Holiday office closings

Blue Cross and BCN offices will be closed July 4 through 5 (Independence Day).

Transitions to post-acute care facilities for Medicare Advantage patients to be managed by naviHealth starting in June

Authorizations for Medicare Plus Blue^SM PPO and BCN Advantage^SM members who require a transfer from acute inpatient hospitals to skilled nursing, long-term acute care or inpatient rehabilitation facilities will be managed by naviHealth, effective June 1, 2019. naviHealth, an independent company that handles caretransitions, will be reviewing both in- and out-of-state post-acute care cases.

For more information, see Page 6 of the May–June 2019 BCN Provider News or the April 2019 issue of The Record.

Medicare Plus Blue PPO claim reimbursements

Effective July 01, 2019, Medicare Plus Blue PPO will implement new reimbursement policies for the following claims billed with Healthcare Common Procedure Coding System or Current Procedural Terminology codes that don’t have an assigned Medicare fee.

• General reimbursements (for non-durable medical equipment and non-laboratory claims)
• Durable medical equipment
• Labs (a reminder of the policy that went into effect July 26, 2016)

For more information, see the April 2019 issue of The Record.

Blue Cross changing practitioner fees July 1

Blue Cross 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^SM members, regardless of customer group.

Blue Cross will use the 2019 Medicare resource-based relative value scale for most relative value unit-priced procedures for dates of service on and after July 1.

For more, see the April 2019 issue of The Record.

Cardiology procedures and in-lab sleep study assessments added to Medicare Plus Blue PPO radiology management program

On May 1, 2019, the radiology management program administered by AIM Specialty Health added authorization requirements for select cardiology procedures and for in-lab sleep study assessments for Medicare Plus Blue PPO members.

The program includes UAW Retiree Medical Benefits Trust members with Medicare Plus Blue coverage. (URMBT commercial PPO members are excluded from the medical necessity assessment requirement.)

For more details, see the June 2019 issue of The Record.

Discharge information may update automatically in e-referral for inpatient care

Recent updates to the e-referral system have improved the efficiency of inpatient authorizations for Michigan facilities. Blue Cross Blue Shield of Michigan and Blue Care Network obtain discharge information through Michigan Health Information Network Shared Services. Through upgrades to the process, e-referral may automatically populate changes to discharge dates.

For more details, see the June 2019 issue of The Record.