|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.|
We’re changing the categorization process for physical therapy
Beginning in January 2020, physical therapists will be assigned to one category — A, B or C — for all four networks: Blue Cross Blue Shield of Michigan, Medicare Plus BlueSM, Blue Care Network and BCN AdvantageSM. Categories are based on the physical therapy paid claims data for all four networks.
Due to the upcoming changes in the categorization process, you won’t be receiving profile reports that were originally scheduled for July 2019 for Blue Cross and for November 2019 for BCN. You’ll maintain your current provider categories and current program requirements until the new combined categories are sent by eviCore healthcare, an independent company, in February 2020. For more details, see Page 4 of the September–October 2019BCN Provider News or the August 2019 issue of The Record. Additional details will be published in the upcoming October 2019 issue of The Record.
We’re making some changes to increase security on Provider Secured Services
Your online security is important to us, so we’re making some changes to Provider Secured Services to help make your information and transactions more secure.
The following changes will go into effect Sept. 12:
For more details, see the Page 1 of the September–October 2019 BCN Provider News or the September 2019 issue of The Record.
Sign up for additional training webinars
We’re continuing our series of training webinars for health care providers and staff. To find out more and register, see Page 4 of the September–October 2019 BCN Provider News or the September 2019 issue of The Record. These webinars will also be announced in the upcoming October 2019 issue of The Record:
BCN offers new University of Michigan student health plan
BCN is offering two new plans for University of Michigan students and their eligible dependents. The U-M Student Health Plan for domestic students was effective Aug. 24. The plan for international students was effective Sept. 1. Both use the self-referral option where members can seek care in or out of network without a referral. See this information on Page 6 of the September–October 2019 BCN Provider News.
Board-certified behavior analysts will need to be licensed to be eligible for reimbursement
Starting Jan. 7, 2020, board-certified behavior analysts practicing in Michigan must be licensed by the State of Michigan to be eligible for reimbursement from Blue Cross and BCN. Board-certified behavior analysts who aren’t licensed aren’t eligible for reimbursement for services provided on or after Jan. 7, 2020.
For more information, see Page 23 of the September–October 2019 BCN Provider News or the September 2019 issue of The Record.
Make sure to download and use the most recent forms
To avoid returned forms or delays in processing, use the latest forms found on bcbsm.com or web-DENIS. Download the necessary forms to ensure you’re always completing the most up-to-date versions. We recommend not storing copies of our forms.
Holiday office closings
Blue Cross and BCN offices will be closed Nov. 28-29 (Thanksgiving).
Auditing began Sept. 1 for Medicare Plus Blue’s reimbursed diagnosis-related group claims
HMS® began auditing Medicare Plus BlueSM PPO’s reimbursed diagnosis-related group claims for clinical and coding validation, starting on Sept. 1, 2019. HMS is an independent company working for Blue Cross Blue Shield of Michigan.
The audits review medical records to ensure claims were billed in accordance with coding guidelines, and diagnoses were supported by documentation in the medical record.
For more information, see the September 2019 issue of The Record.
We’re making changes to the Medicare Advantage SNF postpayment audit, recovery process
Blue Cross Blue Shield of Michigan and Blue Care Network are making changes to the post-payment audit and recovery process for its skilled nursing facilities. The changes will apply to Medicare Plus BlueSM PPO and BCN AdvantageSM members.
For more information, see Page 11 of theSeptember–October 2019 BCN Provider News or the August 2019 issue of The Record.
Inpatient lumbar spinal fusion procedures require two authorizations
Two authorizations are needed for inpatient spinal fusion procedures: one for the procedure and one for the admission.
For more information, see the July 2019 issue of The Record or the Procedures that require authorization by eviCore healthcare.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.