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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. Authorization requirements changed for home health, total parenteral nutrition and intradialytic parenteral nutrition services Home health care
TPN and IDPN services For more information, see the January 2020 message on ereferrals.bcbsm.com, the updated BCN Referral and Authorization Requirements document and the Care Management chapter of the BCN Manual. Inpatient acute care admissions for Blue Cross members submitted through e-referral may be subject to clinical review Throughout 2020, select facilities must submit medical inpatient stays through e-referral. Behavioral health authorization requests and clinical reviews will continue according to follow the current process; however, inpatient admission authorization requests processed through New Directions will be subject to full clinical review from the first day of admission and subject to non-approval. Facilities that need to submit reviews starting in October will be notified midyear. For more information, see the March 2020 issue of The Record. Provider appeal time frame extended for Blue Cross admissions You now have up to 45 days to submit appeals for denied authorization requests related to admissions of Blue Cross commercial members. This applies to admissions for care in acute inpatient settings, skilled nursing facilities, long-term acute care hospitals and inpatient rehabilitation settings. For more information, see the January 2020 issue of The Record. Holiday office closings Blue Cross and BCN offices will be closed April 10 (Good Friday) and May 25 (Memorial Day). Blue Cross 101: Understanding the Basics training webinar Provider Experience is continuing its series of training webinars for health care providers and staff. Our next training webinar will be held on Tuesday, May 12, 10 to 11:30 a.m. To register, see the April 2020 issue of The Record. Important information about peer-to-peer reviews and appeals When we deny your request to authorize an inpatient or outpatient service, you can ask for a peer-to-peer review or you can appeal the denial. Whether you’re requesting a peer-to-peer review or submitting an appeal, there’s important information you need to know. For detailed information, see Page 34 of the March–April 2020 BCN Provider News or the January 2020 and March 2020 issues of The Record. Drugs to treat members with opioid use disorder and behavioral health conditions now payable in home or AICs Beginning Jan. 1, 2019, select injectable medications are payable in the home setting through home infusion therapy and in ambulatory infusion centers without requiring medical IV therapy on the same day. We’ve expanded the list of applicable drugs to assist members struggling with opioid addiction and chronic behavioral health conditions. For more information, as well as a list of drugs now included, see the January 2020 issue of The Record. Blueprint for Affordability gets more traction We’re pleased to announce the second wave of health care provider organizations that have agreed to sign risk-sharing arrangements with Blue Cross Blue Shield of Michigan as part of Blueprint for Affordability. We’ll continue to update you as Blueprint for Affordability evolves. For now, you can read more about it at BlueprintForAffordability.com. For more information, see the March 2020 issue of The Record. TurningPoint to manage authorizations for musculoskeletal procedures with dates of service on or after June 1 for certain members Providers will need to submit authorization requests through TurningPoint Healthcare Solutions LLC for all surgical procedures related to musculoskeletal conditions scheduled to occur on or after June 1, 2020, for BCN commercial members, as well as BCN AdvantageSM and Medicare Plus BlueSM members. This pertains to procedures currently managed by Blue Cross or BCN. These changes don’t apply to Blue Cross commercial plans. For more information, see Page 37 of the March–April 2020 BCN Provider News or the March 2020 issue of The Record. Reporting instructions for Blue Cross or FEP supplemental when MA is primary payer When a member has a Medicare Advantage or Medicare Advantage HMO primary and a Blue Cross Blue Shield of Michigan or Federal Employee Program supplemental policy, remember to report the primary payer with a claim filing indicator of MA or MB in loop 2320. For more information on how to complete these claims, see the January 2020 issue of The Record. |
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