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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. May is Mental Health Month May is Mental Health Month, a good time to remind your patients of the important role that good mental health plays in overall wellness. There are several resources your offices can utilize for this effort.
Submit BCN initial and follow-up authorization requests for PT, OT and ST to eviCore starting May 27, 2019 Starting May 27, 2019, submit all BCN authorization requests for outpatient physical, occupational and speech therapy by therapists and physical medicine services by chiropractors to eviCore healthcare. This includes requests for both initial and follow-up visits, for both BCN HMOSM (commercial) and BCN AdvantageSM members. For more information, see the Page 35 of the May – June 2019 BCN Provider News. To learn about the changes involved in submitting these requests to eviCore, sign up now for the eviCore webinar training sessions. Find webinar dates and registration instructions on Page 37 of the May – June 2019 BCN Provider News. Holiday office closings Blue Cross and BCN offices will be closed May 27 (Memorial Day). Provider Secured Services reminders To maintain access to Provider Secured Services without disruption, please make sure your user ID and password are active.
Use your company email for access requests Locating your provider consultant
Clarification on reimbursement of CPT code *99354 The American Medical Association updated the nomenclature for CPT code *99354 to include If ineligible providers bill this code, it will reject as not payable for your specialty and provider liability will apply. *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved. How to request retroactive prior authorization for commercial PPO Radiology Management Program Providers have up to 90 days past the date of service to request retro prior authorization through AIM Specialty HealthSM for Blue Cross Blue Shield of Michigan commercial PPO members participating in our Radiology Management Program. Although 90 days is allowed, we encourage providers to obtain prior authorization before administering services. For more information, see the May 2019 issue of The Record. New HEDIS CBP measure specifications eliminate need for medical record reviews The controlling high blood pressure HEDIS®, or Healthcare Effectiveness Data and Information Set, specifications previously 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 and you won’t need to include medical records for confirmation. For more information, see the May 2019 issue of The Record. HEDIS is a registered trademark of the National Committee for Quality Assurance. Reminder: Prior authorization changes to AIM authorization program for MA PPO members begin May 1, 2019 Starting May 1, 2019, certain cardiac procedures and in-lab sleep testing will require prior authorization through AIM Specialty Health for Medicare Plus BlueSM PPO members. This includes UAW Retiree Medical Benefi ts Trust members with Medicare Plus Blue coverage. For more details about the expanded cardiology services and in-lab sleep testing, see the May 2019 issue of The Record. Reminder: Northwood to cover DME/P&O utilization management and claims for Medicare Plus Blue PPO starting in May Northwood Inc., an independent company that manages the durable medical equipment, prosthetics, orthotics and medical supply provider network for Medicare Plus BlueSM PPO members, will also handle authorizations, utilization management and claims processing, starting in May. For more information, see the February 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. |