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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.
Checking the status of temporary measures for COVID‑19 Blue Cross Blue Shield of Michigan and Blue Care Network have made many temporary changes to support providers and protect members during the COVID‑19 pandemic. Some of those changes have ended and one has been extended. For the latest status of all temporary measures, see the Temporary changes due to the COVID‑19 pandemic document, which shows the start and end dates for each measure, found on our public website at bcbsm.com/coronavirus and through Provider Secured Services. For more information, see Page 34 of the July–August 2020 BCN Provider News or the August 2020 issue of The Record. Blue Care Network extends Healthy Blue LivingSM deadlines Due to the ongoing COVID‑19 pandemic, BCN is providing new extensions for Healthy Blue Living requirements for members in groups that are new or renewing January through July of this year. Members now have the entire plan year to complete the requirements. For more information, see Page 5 of the July–August 2020 BCN Provider News. Recommendations for submitting authorization requests for medical oncology drugs to AIM Follow these recommendations for submitting authorization requests for medical oncology drugs to AIM Specialty Health® to ensure a more efficient authorization review process.
This information applies to all Blue Cross PPO, Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members whose plans require authorization of medical oncology drugs by AIM. For more information, see Page 27 of the July–August 2020 BCN Provider News or the June 2020 issue of The Record. eviCore simplifies authorization process for radiation oncology Beginning July 1, 2020, eviCore healthcare simplified the authorization process for radiation oncology so that you’ll see fewer clinical questions on authorization requests. As part of the process, eviCore will be asking clinical decision support questions, rather than traditional clinical questions. This change applies to authorizations for breast, prostate and non-small-cell lung cancer. For more information, see the August 2020 issue of The Record, and Blue Cross eviCore-Managed Procedures and BCN eviCore-Managed Procedures pages of ereferrals.bcbsm.com. TurningPoint musculoskeletal authorization program to expand Blue Cross will add commercial members to the TurningPoint Healthcare Solutions, LLC musculoskeletal program for spine, pain management and joint replacement surgeries and related procedures for dates of service on or after Jan. 1, 2021. At that time, the program will also expand to include pain management procedures for BCN HMOSM, BCN AdvantageSM and Medicare Plus BlueSM PPO members. In addition, spinal procedures for Medicare Plus BlueSM PPO members will transition from being managed by eviCore healthcare® to being managed by TurningPoint. For more information, see the August 2020 issue of The Record. 2020 InterQual® criteria implemented Aug. 1 Blue Cross and BCN implemented 2020 InterQual criteria starting Aug. 1, 2020, for all levels of care. We’ll use these criteria to make utilization management determinations for requests to authorize non-behavioral health services subject to review for Blue Cross PPO, Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members. Read more on Page 23 of the July–August 2020 BCN Provider News or the July 2020 issue of The Record. New information about ePA for drugs covered under pharmacy benefits If you use an electronic prior authorization, or ePA, tool to request authorization for drugs that are covered under pharmacy benefits, there is new information you need to know. For complete details, see the August 2020 issue of The Record. Medicare Part B medical specialty drug prior authorization list changing We’re making changes to the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus BlueSM PPO and BCN AdvantageSM members. The specialty medications on this list are administered by a health care professional in a provider’s office, at the member’s home, in an off-campus outpatient hospital or in an ambulatory surgical center (place of service 11, 12, 19, 22 or 24). For more information, see the August 2020 issue of The Record. On-demand training available Provider Experience is continuing to offer training resources to help clinical and administrative staffs work more efficiently with Blue Cross and BCN. You can now access recordings of provider training webinars delivered so far in 2020 through web-DENIS. For more information, see the Page 9 of the July–August 2020 BCN Provider News or the August 2020 issue of The Record. eviCore has updated corePath for physical and occupational therapy authorizations Effective immediately, eviCore healthcare has made changes to the corePathSM therapy authorization model for initial authorization requests for new episodes of treatment. This change applies to:
For more information, see the August 2020 issue of The Record. Blues Brief survey results Earlier this year, we conducted an online survey to find out how satisfied you are with the monthly professional, quarterly facility and specialty versions of Blues Brief. Read the results in the August 2020 issue of The Record or the upcoming issue of the September–October 2020 BCN Provider News. | |
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |