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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.
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. Medical benefit specialty drug prior authorization lists are changing in July and August for Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members We’re adding authorization requirements for four specialty drugs covered under the medical benefit for Medicare Plus Blue PPO, BCN HMO and BCN Advantage members. For dates of service on or after July 24, 2020, the following drugs will require authorization through AIM Specialty Health®:
For dates of service on or after Aug. 24, 2020, the following drug will require authorization through AIM:
For more information, see Page 13 of the July–August 2020 BCN Provider News or the July 2020 issue of The Record. Two UAW groups have similar names, causing some confusion Because of their similar names, there has been some confusion about whether the UAW Retiree Health Care Trust, UAW International Staff or UAW Retiree Medical Benefits Trust require prior authorization from AIM Specialty Health for select outpatient medical diagnostic services. Keep in mind that the URHCT and the UAW International Staff do not require preauthorization, while URMBT does. For more information, see the May 2020 issue of The Record.
New quantity limits for morphine Effective May 1, 2020, certain long-acting morphine products require new quantity limits for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. A prior authorization is required for members who received a prescription on or after May 1, 2020, under the new quantity limits. For more information, see Page 30 of the May–June 2020 BCN Provider News or the March 2020 issue of The Record. Radiation therapy services for A9590 require prior authorization for all Blue Cross, BCN members For dates of service on or after April 1, 2020, services associated with HCPCS code A9590 (iodine i-131, iobenguane, 1 millicurie) require prior authorization by eviCore healthcare. This applies to all Blue Cross and BCN members with plans subject to eviCore healthcare authorization requirements. For more information, see Page 35 of the March–April 2020 BCN Provider News or the March 2020 issue of The Record. HEDIS® measure tip sheets updated for 2020 We’ve updated our HEDIS tip sheets for 2020 and posted them on the Clinical Quality Corner page of web-DENIS, along with a series of Star Measure Tips that were posted earlier this year. The tip sheets were developed to assist health care providers and their staff in their efforts to improve overall health care quality and prevent or control diseases and chronic conditions. For more details, see the May 2020 issue of The Record. HEDIS® is a registered trademark of the National Committee for Quality Assurance. | ||
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |