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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. Changes to BCN member transfer request form We’ve made the following changes to the form you use to ask us to transfer a member to another BCN primary care physician:
You can access the process description and the form in a single document posted on BCN’s Forms page within Provider Secured Services:
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 the October 2019 issue of The Record. Direct reimbursement available to clinical nurse specialists, Jan. 1 Clinical nurse specialists will have the opportunity to participate in Blue Cross Blue Shield of Michigan’s Traditional and TRUST PPO networks and Medicare Plus BlueSM, as well as the BCN HMOSM and BCN AdvantageSM, starting Jan. 1, 2020. Participating clinical nurse specialists will receive direct reimbursement for covered services within the scope of their licensure at 85% of the applicable fee schedule, minus any member deductibles and copayments. For more information, see the October 2019 issue of The Record. We’ll cover hemophilia drugs under the pharmacy benefit for most commercial members, starting Jan. 1 Starting Jan. 1, 2020, if a commercial, non-Medicare member has Blue Cross or BCN pharmacy coverage, all hemophilia drugs should be billed under their pharmacy benefits. If a member has pharmacy coverage through a company other than Blue Cross or BCN, hemophilia drugs will continue to be covered under the medical benefit. Also, groups with administrative service contracts can opt out and continue to use the medical benefit for hemophilia drugs. For more details, see the October 2019 issue of The Record. 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. Changes to reimbursement policy for board-certified behavior analysts take place Jan. 1 Effective Jan. 1, 2020, the following two reimbursement policy changes affecting board-certified behavior analysts will occur.
Read more in the October 2019 issue of The Record. Physical, occupational and speech therapy claims require appropriate modifier Blue Cross Blue Shield of Michigan is updating the claims processing system to require all outpatient physical, occupational and speech therapy claims to be billed with one of the following therapy modifiers: GN, GO or GP. The updated claims processing system will reject all professional outpatient therapy services submitted without an appended modifier. The system update is expected to be completed in early 2020. Read more in the October 2019 issue of The Record. Here’s when to bill for an originating site facility fee Providers have expressed some confusion about when and how to bill for the telehealth originating site facility fee (HCPCS code Q3014). Providers should only bill the originating site facility fee when telehealth technology is used to connect the patient to a provider at a distant location. If the patient is in the same location of the provider who is rendering a professional service, the originating site code isn’t required and, therefore, is not payable. See the October 2019 issue of The Record for more information. Reference Based Benefits feature closing Dec. 31 Effective Dec. 31, 2019, Blue Cross Blue Shield of Michigan is closing the Reference Based Benefits feature. The RBB feature allows employers to set a maximum (reference) price for their employees’ select inpatient, outpatient and imaging services. See the October 2019 issue of The Record for more information. Changes to all Blue Cross practitioner participation agreements announced Effective Jan 1, 2020, changes will be made to the amendment provisions for all Blue Cross professional practitioner agreements and the Blue Cross MAPPO agreement. For more information regarding these provisions, see the October 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. |