|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.|
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HEDIS® quality measure changes
In October, the National Committee for Quality Assurance released value set changes for the following HEDIS quality measures:
HEDIS® is a registered trademark of the National Committee for Quality Assurance.
Physical, occupational and speech therapy outpatient professional claims to require appropriate modifier
Effective May 1, 2020, physical, occupational and speech therapy providers must append the appropriate modifier to procedure codes for all outpatient professional claims for physical, occupational and speech therapy services.
Outpatient professional claims billed without a therapy modifier will be rejected as provider liable. 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.
Non-medical behavioral health practitioners can now be reimbursed for prolonged psychotherapy services
For dates of services on or after Feb. 1, 2020, non-medical behavioral health practitioners are eligible for reimbursement of services associated with procedure codes *99354 and *99355.
These apply to evaluation and managementrelated psychotherapy services in the office or other outpatient setting when they require direct patient contact beyond the usual time.
*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.
New Blue Cross and BCN members to be issued alphanumeric subscriber IDs in 2020
Blue Cross and Blue Care Network will begin issuing alphanumeric subscriber IDs to new members, starting July 1, 2020. New IDs will begin with the letter M after the prefix. For example, a new subscriber ID will look like this: XYZM91234567. Read more on Page 8 of theMarch–April 2020 BCN Provider News.
Radiation therapy services for A9590 require prior authorization for all Blue Cross, BCN members starting April 1
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 Blue Shield of Michigan and Blue Care Network members with plans subject to eviCore healthcare authorization requirements. For more details, see Page 35 of the March–April 2020 BCN Provider News or the March 2020 issue of The Record.
Blue Distinction Specialty Care takes aim at opioid use disorders
Blue Cross Blue Shield of Michigan, along with the Blue Cross and Blue Shield Association, has launched another tool in its battle against opioid use disorders — a Blue Distinction® Center designation for substance use treatment and recovery. It requires designated facilities to deliver coordinated multidisciplinary care to patients and provide timely access to quality medical and psychosocial care in all phases of treatment. Read more on Page 1 of the March–April 2020 BCN Provider News or the March 2020 issue of The Record.
BCN medical directors are a resource for physicians
Plan medical directors work throughout the state with affiliated practitioners and providers to ensure appropriate care and service for BCN members. They provide clinical support for utilization management activities, assist with the appropriate use of clinical resources, adjudicate provider appeals and much more. Read more on Page 5 of the March–April 2020 BCN Provider News.
Plan to attend our 2020 provider symposiums
Blue Cross and BCN’s 2020 provider symposiums, A Treatment for Success, will begin in late April. For dates and locations, see the March 2020 issue of The Record.
2020 Quality Rewards booklet now available
The Quality Rewards program is Blue Cross and BCN's Performance Recognition Program and Physician Group Incentive Program combined. The booklet helps primary care physicians and practices understand their role in providing high quality care to their patients. The booklet can be found on BCN Health e-BlueSM, BCBSM Health e-Blue or BCBSM Medicare Advantage Health e-Blue in the Resources section.
Sign up for additional training webinars
Provider Experience is continuing its series of training webinars for health care providers and staff. For a list of webinars, dates and times, see Page 9 of the March–April 2020 BCN Provider News or the March 2020 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.