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 identifies 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.

Pathway regimens

Cancer Treatment Pathways support high-quality, high-value cancer treatment. A rigorous process is applied to evaluate regimens supported by national guidelines, such as NCCN, oncology professional society practice guidelines, and by peer-reviewed published data. Factors considered include:

• Clinical benefit (efficacy)
• Side-effects (toxicity) - especially those that lead to hospitalizations or impact quality of life
• Cost (when efficacy and toxicity are equal)

Enhanced reimbursement for providers

By choosing a Pathway regimen, when clinically appropriate, the ordering provider may be eligible for enhanced reimbursement. The AIM ProviderPortal^SM will display S-codes for the provider to bill BCN:

• S0353: Treatment planning and care coordination for cancer – initial treatment
• S0354: Treatment planning and care coordination for cancer, established patient

How to identify members in the program

This program has already been implemented for Blue Cross URMBT PPO non-Medicare. To easily identify members included in the program refer to membership ID cards as shown at the top right.

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.

Reminder: Prior authorization changes for Blue Cross URMBT non-Medicare members, effective Jan. 1, 2019

Effective Jan. 1, 2019, Blue Cross began two new utilization management programs for medical and radiation oncology services delivered to UAW Retiree Medical Benefi ts Trust non-Medicare members. The programs require prior authorization for some outpatient through AIM Specialty Health.

URMBT non-Medicare members who were in a treatment course prior to Jan. 1, 2019 were included in the continuity of care process.

Read more in the November 2018 issue of The Record.

Sign up to receive Blues Brief electronically

As announced previously, Blues Brief is now 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.

RC Claim Assist helps you bill for drugs under the medical benefit

RC Claim Assist is available to Blue Cross and BCN contracted providers, and it’s a free resource for you to use. The benefi ts of using this tool are that it gives you an overview of HCPCS and CPT* drug codes, product names and national drug codes. In addition, it offers complete drug information on package-size billable units and reference pricing.

To learn more, please see these resources on ereferrals.bcbsm.com. Click BCN or Blue Cross, then click the Medical Benefit Drugs – Pharmacy page:

• RC Claim Assist webinar presentation (PDF)
• Frequently asked question about RC Claim Assist (PDF)
• Link to the RC Claim Assist log-in page
• Billing instructions: Reporting the National Drug Code (PDF)

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.

Holiday office closings

Blue Cross and BCN offi ces will be closed May 27 (Memorial Day) and July 4-5 (Independence Day).

Utilization management programs summary document updated

The Summary of utilization management programs for Michigan providers (PDF) has been updated with the changes listed below and is now available on ereferrals.bcbsm.com. Click BCN or Blue Cross, then the Authorization Requirements & Criteria page (formerly Clinical Review & Criteria Charts):

Medical oncology drugs –

• For all lines of business, we added NovoLogix information.
• For one Blue Cross ACS group (UAW Retiree Medical Benefi ts Trust non-Medicare members), AIM Specialty Health started managing these authorizations on Jan. 1, 2019.

Radiation oncology –

• For one Blue Cross ASC group (UAW Retiree Medical Benefi ts Trust non-Medicare members), AIM started managing authorizations on Jan. 1, 2019.

CAQH Direct Assure 2.0 phases III and IV continue to roll out

CAQH Direct Assure allows you to see specific group affiliation information that’s in our system so you can make updates and add group information to an individual provider’s CAQH record. Direct Assure also allows certain group changes made in CAQH to update the Blue Cross system so you no longer have to make updates in both areas — the CAQH and Blue Cross systems.

Phase IV is scheduled to roll out at the end of June to specialists who are likely to be audited by the Centers for Medicare & Medicaid Services, including primary care physicians, cardiologists, oncologists and ophthalmologists. For more information, see the May 2019 issue of The Record.