Oncology management program for Medicare Advantage plans begins in January

A new utilization management program for medical oncology for Medicare Plus Blue^SM PPO and BCN Advantage^SM members will begin in January 2020. Providers will need to obtain authorizations from AIM Specialty Health^® for certain medical oncology and supportive care medications.

How to identify members in the program
This program has already been implemented for Blue Cross URMBT PPO non-Medicare and BCN HMO^SM (commercial). To easily identify members included in the program refer to membership ID cards as shown below.

To learn more and for the dates of upcoming webinars, see Page 10 of the September –October 2019 BCN Provider News or the October 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 the October 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.

We’ve made some changes to increase security on Provider Secured Services

Your online security is important to us, so we’ve made some changes to Provider Secured Services to help make your information and transactions more secure.

The following changes went into effect Sept. 12:

• Your user ID will be deactivated after 90 days of inactivity.
• We’ll maintain a password history of six passwords. When you change your password, it must be different from your previous six passwords.
• Password length is changing to a minimum of eight characters.
  • New passwords must contain at least one:
    • Number
    • Upper case letter
    • Lower case letter
    • Special character
• Your password can’t be the same as your user ID.
• You’ll need to change your password every 60 days. The system will prompt you when it’s time to do so.

For more details, see Page 1 of the September–October 2019 BCN Provider News or the September 2019 issue of The Record.

HEDIS measure tip sheets and Star measure tips posted on web-DENIS

As part of our ongoing collaborative efforts with our participating physicians to improve health care quality, we’ve updated our HEDIS^® measure tip sheets for 2019. The tip sheets highlight specific measures that are included in the Healthcare Effectiveness and Data Information Set, commonly called HEDIS. The tip sheets have been posted on web-DENIS along with our Star measure tips. They cover such topics as:

• Cervical cancer screening
• Breast cancer screening
• Colorectal cancer screening

Click on BCBSM Provider Publications and Resources or BCN Provider Publications and Resources to access them. For example, from BCN Provider Publications and Resources, you would click on Clinical Quality Corner to see both the HEDIS and Star tip sheets. For more information, see the August 2019 issue of The Record and the September 2019 issue of The Record.

Utilization management programs summary document updated

The Summary of utilization management programsfor 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 Benefits 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 Benefits Trust non-Medicare members), AIM started managing authorizations on Jan. 1, 2019.

Holiday office closings

Blue Cross and BCN offices will be closed Nov. 28-29 (Thanksgiving).