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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. BCN offers 19 individual products for 2020 Blue Care Network is offering 19 products for the 2020 marketplace:
As always, check member eligibility and benefits at every visit before providing services. You can do this through web-DENIS or by calling Provider Inquiry at 1-800-344-8525. Read more on Page 1 of the November–December 2019 BCN Provider News. Outpatient therapy benefit change for Jan. 1, 2020 BCN is changing its outpatient therapy visit limit to 60 visits per year for combination of therapies. Currently, the benefit is one period of treatment within 60 consecutive days per year for a combination of therapies. The change is effective Jan. 1, 2020, for large groups of 51 members and greater with the following certificates:
The benefit enhancement is driven by the large number of member grievances about outpatient therapy limit and change in care management practices. Now, members who start physical therapy to avoid surgery and end up having surgery will be able to seek post-surgery physical therapy without exhausting their benefit. Read more on Page 3 of the November–December 2019 BCN Provider News. Holiday office closings Blue Cross and BCN offices will be closed Nov. 28 and 29 for the Thanksgiving holiday. BCN Referral and Authorization Requirements document updated The BCN Referral and Authorization Requirements document now includes links to the preview questionnaires for all services for which questionnaires open in the e-referral system. This includes questionnaires that began opening on June 23 and Aug. 25, 2019. The document can be found on the BCN Authorization Requirements & Criteria page of ereferrals.bcbsm.com. New BCN Health e-BlueSM User Guide available A guide to help providers use the BCN Health e-Blue system is now available. This step-by-step guide shows providers how to get started, find patient detail including eligibility, treatment opportunities by condition/measure, diagnosis gaps and more. To access the document:
Tell us how satisfied you are with our Utilization Management services — survey now open Blue Cross and BCN want to know how satisfied you are with our Utilization Management services. Let us know by completing a short survey at tinyurl.com/y5ukrfr9. The survey closes Dec. 31, 2019. Encourage your office colleagues, including physicians, nurses and referral coordinators, to take the survey as well so we can improve our processes to better support you as you care for our members. Star Quality news: Blue Cross and BCN earn 4 stars The Centers for Medicare & Medicaid Services announced the 2020 star ratings. The Medicare star-ratings program is a nationally recognized measurement program, providing an overall rating of a health plan’s quality and performance for the types of services each plan offers. Every year, CMS announces ratings for Medicare Advantage plans, which range from 1 (lowest) to 5 (highest) stars. Blue Cross and BCN received an overall 4.0-star rating from CMS. Maintaining a 4.0 or higher star rating is important because it is required to receive a quality bonus payment from CMS. Read more on Page 8 of the November–December 2019 BCN Provider News. Reminder: Oncology management program for MA plans begins in January A new utilization management program for medical oncology for Medicare Plus BlueSM PPO and BCN AdvantageSM members will begin in January 2020. Providers will need to obtain authorizations from AIM Specialty Health® for certain medical oncology and supportive care medications. To learn more and for the dates of upcoming webinars, see Page 9 of the November–December 2019 BCN Provider News or the November 2019 issue of The Record. Sign up today: New training webinars for providers and staff We're continuing our series of training webinars for health care providers and staff. The webinars are designed to help you work more efficiently with Blue Cross and BCN. To find out more and register, see Page 6 of the November–December 2019 BCN Provider News or the November 2019 issue of The Record. We’re updating the Locum Tenens Arrangements medical policy Blue Cross Blue Shield of Michigan is updating the Locum Tenens Arrangements medical policy guidelines, effective Dec. 1, 2019. A locum tenens (temporary) provider delivers medical care in the office of a fully credentialed network provider who is unavailable due to illness, pregnancy, vacation, participation in continuing medical education or being called to active duty as a member of a reserve component of the Armed Forces. This policy update affects any fully licensed, contracted provider who is eligible for direct reimbursement from Blue Cross. For more information, see the November 2019 issue of The Record, as well as the medical policy. MESSA is reprocessing 2019 mental health claims for certain services MESSA has made retroactive changes to its member copayments for certain mental health services for 2019. As a result, we’re advising our participating providers that Blue Cross will be reprocessing their mental health claims for certain services for the period of Jan. 1 through Dec. 31, 2019. This affects the following MESSA Choices and Essentials by MESSA group numbers: BCBSM 71452, 71453; BCS 71538, 71539. For more information, see the November 2019 issue of The Record, or call Provider Inquiry |
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |