Download a printable version to read or shareJanuary 2020
|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.|
Welcome to the first edition of Blues Brief for chiropractic offices
This special issue of Blues Brief is designed to cover topics of interest just for you. It will be published at least once per year. For more frequent news from us, you can subscribe to our monthly edition of Blues Brief for professional providers or quarterly edition for hospitals and facilities. These publications, along with the BCN Provider News and The Record newsletters, are available via email subscription. To sign up and avoid possible subscription errors, add Blues Brief to your subscriptions by clicking the Manage Subscriptions link at the bottom of your BCN Provider News or The Record newsletter emails. You can also visit the Our Provider Newsletters subscription page on bcbsm.com/providers to choose your preferred Blues Brief versions. Read more on Page 6 of the March–April 2019 BCN Provider News or the March 2019 issue of The Record.
Reminder: Plan notifications still required for BCN AdvantageSM members staying in network
As published on Page 7 of the March–April 2019 BCN Provider News, Blue Care Network no longer accepts referrals for BCN Advantage members to see a provider in their health plan’s network. However, plan notifications are still required for chiropractic services. Please refer to the referral information for chiropractic services on Page 2 of the BCN Referral and Authorization Requirements (PDF) on ereferrals.bcbsm.com.
Reminder: What you need to know about therapeutic massage
Blue Cross Blue Shield of Michigan reimburses for therapeutic massage as a part of an overall physical medicine treatment plan if the following criteria are met:
Medically necessary therapeutic massage may be delivered by participating providers when such massage is within their scope of practice. Chiropractors may perform this service when it's a part of a complete physical medical plan; they may not supervise other provider types in performance of therapeutic massage. Read more in the January 2018 issue of The Record.
No authorization required for BCN initial PT, OT and ST evaluations
As a reminder, BCN no longer requires authorization for initial evaluations for physical, occupational and speech therapy by therapists or for physical medicine services by chiropractors. Also, the initial evaluation should be completed before you request authorization for treatment. If you submit the request before the evaluation, you may not be able to complete all of the required questions in the pathway, which could result in your request being pended.
For more information, see the message posted under June 2019 on ereferrals.bcbsm.com and the Outpatient rehabilitation services: Frequently asked questions (PDF).
Holiday office closings
Blue Cross and BCN offices will be closed Jan. 20 (Martin Luther King Jr. Day).
Contact eviCore’s Client & Provider Services for help using the evicore.com portal for BCN PT, OT and ST authorizations
Need help submitting authorization requests or finding cases in the eviCore healthcare provider portal? Contact eviCore’s Client & Provider Services department to get help. Email clientservices@eviCore.com to get eviCore’s assistance with authorization requests for outpatient physical, occupational and speech therapy and physical medicine services by chiropractors for BCN HMO or BCN Advantage members. For urgent cases, call eviCore at 1-800-646-6418; select option 4. For more details, see Page 37 of the September–October 2019 BCN Provider News.
HEDIS tip sheets available
As part of our ongoing collaborative efforts with our participating physicians to improve health care quality, we provide HEDIS® measure tip sheets. The tip sheets highlight specific measures that are included in the Healthcare Effectiveness and Data Information Set, commonly called HEDIS.
These PDFs can be found on web-DENIS. Click BCN Provider Publications and Resources then Clinical Quality Corner. Or go to BCBSM Provider Publications and Resources, click on Newsletters and Resources and then Clinical Quality Corner. When the 2020 versions are available later this year, we will replace the 2019 versions currently shown. For more information, see the August 2019 issue of The Record.
HEDIS® is a registered trademark of the National Committee for Quality Assurance.
Tips to manage acute low back pain in adults
According to the Michigan Quality Improvement Consortium, 90% of low back pain episodes resolve within six weeks, regardless of treatment. Typically, imaging isn’t required within the first six weeks, unless certain red flags are present. Red flags include, but aren’t limited to:
Read more in the December 2019 issue of The Record or on Page 27 of the January-February 2020 BCN Provider News.
We've made changes to all Blue Cross practitioner participation agreements
We’ve made changes to the amendment provisions for all Blue Cross professional practitioner agreements and the Blue Cross Medicare Advantage PPO agreement, which went into effect Jan. 1, 2020. See the changes in the October 2019 issue of The Record.
We’re encouraging physician organizations to recruit more chiropractors
Although Blue Cross members frequently use chiropractic and mental health services, the number of participating chiropractors, psychiatrists and fully licensed psychologists in our Physician Group Incentive Program physician organizations lags behind the number of providers in other specialties. We’ve increased the engagement reward for POs that recruit psychiatrists, fully licensed psychologists and chiropractors from $500 per new practitioner to $1,000 per new practitioner in 2019 and will continue in 2020. Read more in the February 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.