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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. Providers and office staff: Sign up for new training webinars Do you or your staff have questions about provider enrollment, pharmacy or you just need a refresher on how to work more efficiently with Blue Cross Blue Shield of Michigan and Blue Care Network? Well, now there’s a webinar to help with those questions. Read more and find a list of upcoming webinar offerings on Page 1 of the July–August 2019 BCN Provider News. CAQH Direct Assure rollout continues through 2019 We’re continuing to roll out Direct Assure in phases with the goal to have all providers using it by the end of December 2019. Currently, 25% of our practitioners participate. We’ll roll out Phase IV at the end of June. Practitioners included in this rollout are specialists who are likely to be audited by the Centers for Medicare & Medicaid Services:
Read more on Page 4 of the July–August 2019 BCN Provider News. Reminder: New oncology management program starting Aug. 1 The Oncology Management Program for BCN 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. To learn more, see Page 26 of the May–June 2019 BCN Provider News. New HEDIS® blood pressure measure specifications eliminate need for medical record reviews The controlling high blood pressure HEDIS measure has been updated to assess patients ages 18 to 85 who had a diagnosis of hypertension and whose blood pressure was adequately controlled (less than 140/90) during the last reading of the year. Previous CBP HEDIS, or Healthcare Effectiveness Data and Information Set, specifications required medical record reviews to determine if a patient’s blood pressure was under control. Now, Blood Pressure CPT Category II results codes will determine compliance. Read more on Page 24 of the July–August 2019 BCN Provider News. HEDIS® is a registered trademark of the National Committee for Quality Assurance. How to confirm the networks you participate in We have a document that helps providers find the Blue Cross and BCN products they participate in. Finding your Blues plans shows you how to use the online provider search to confirm which products you accept. When new patients present themselves or current patients change health plans, you’ll know if you accept the plan they have. To find the document, see Page 2 of the May–June 2019 BCN Provider News. Holiday office closings Blue Cross and BCN offices will be closed July 4 and 5 (Independence Day). Blue Cross, BCN accepting claims for applied behavior analysis services with 2019 procedure codes For dates of service on or after June 1, 2019, Blue Cross and BCN are accepting claims for applied behavior analysis services billed with the following codes:
For more information about billing guidelines, see the July 2019 issue of The Record. *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. We’re using updated utilization management criteria for behavioral health On Aug. 1, 2019, Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM will begin using the 2019 InterQual® criteria for behavioral health utilization management determinations. In addition, certain types of determinations will be based on modifications to InterQual criteria or on local rules or medical policies. For more information, see the July 2019 issue of The Record. 2019 InterQual® criteria to be implemented Aug. 1 for non-behavioral health determinations Blue Cross and BCN will start using the 2019 InterQual criteria on Aug. 1, 2019, for all levels of care. We’ll use these criteria to make utilization management determinations for requests to authorize non-behavioral health services subject to review for the following members:
For more information, see Page 13 of the July–August 2019 BCN Provider News or the July 2019 issue of The Record. We invite you to join PGIP as a physician organization Our Physician Group Incentive Program offers incentives to participating practitioners, physician organizations and organized systems of care for improving health care delivery. We’ll be accepting applications for PGIP from new POs from Aug. 1 through Aug. 31, 2019. To request application materials, send an email to valuepartnerships@bcbsm.com. For more information about PGIP, see the July 2019 issue of The Record. Comprehensive lists of requirements for medical specialty drugs and pharmacy benefit drugs available We’ve developed comprehensive lists of requirements for medical specialty and pharmacy benefit drugs for Blue Cross PPO and BCN HMO commercial members. These lists include current information on utilization management requirements. For more details and how to view the lists online, see the July 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. |