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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.
We’re extending fee schedule changes for home health care, home infusion therapy due to COVID-19 In response to the COVID-19 pandemic, Blue Cross Blue Shield of Michigan and Blue Care Network modified reimbursement policies that apply to practitioners who must deliver care in the members’ home rather than using telemedicine. For more information, see Page 3 of the September–October 2020 BCN Provider News or the September 2020 issue of The Record. TurningPoint musculoskeletal authorization program to expand The TurningPoint Healthcare Solutions musculoskeletal surgical authorization program is expanding for pain management, orthopedic and spinal procedures effective for dates of service on or after Jan. 1, 2021. This change affects procedures currently managed by Blue Cross, BCN or eviCore healthcare®. For more information, including groups and members affected, procedure codes and available webinar training, see Page 33 of the September–October 2020 BCN Provider News or the September 2020 issue of The Record. Oncology management program to include Blue Cross commercial members, starting in December Beginning Dec. 1, 2020, Blue Cross will expand its utilization management program for medical oncology to include all fully insured commercial members. With this expansion, providers will need to request authorization from AIM Specialty Health® for certain medical oncology and supportive care medications for PPO members. For more information, see the September 2020 issue of The Record. Skilled nursing facilities to follow new process to submit authorization requests Starting Dec. 1, 2020, skilled nursing facilities will be required to submit authorization requests for members of our commercial plans through the e-referral system. This updated submission process applies to requests for admissions and additional days. Skilled nursing facilities will no longer be able to submit their requests by fax. This change affects members of Blue Cross Blue Shield of Michigan and Blue Care Network commercial plans. For more information, see Page 36 of the September–October 2020 BCN Provider News or the September 2020 issue of The Record. Holiday office closings Blue Cross and BCN offices will be closed Nov. 3 (Election Day) and Nov. 26-27 (Thanksgiving). Michigan Value Collaborative: Combating congestive heart failure The Michigan Value Collaborative is helping to change the high amount of people readmitted for heart failure post-hospital discharge. MVC provides claims data to hospitals that allows them to see how they’re performing on this quality measure and many others. The data is then used by hospitals to develop strategies for improving quality and lowering health care costs. Read more about the initiatives developed by participating MVC hospitals in the July–August 2020 Hospital and Physician Update. To subscribe to Hospital and Physician Update and our other provider newsletters, visit bcbsm.com/providers and then click Subscribe. 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 Page 7 of the September–October 2020 BCN Provider News or the August 2020 issue of The Record. AllianceRx Walgreens Prime specialty pharmacy program starts Jan. 1 for most Blue Cross commercial members AllianceRx Walgreens Prime will be the exclusive specialty pharmacy provider for Blue Cross commercial members, effective Jan. 1, 2021. You’ll need to give your patients new prescriptions before Jan. 1, 2021, if they don’t currently fill their specialty drug prescriptions at AllianceRx Walgreens Prime or a local Walgreens pharmacy location. If you don’t, your patients could be responsible for the full cost of their drugs. For more information, see the September 2020 issue of The Record. IVIG dosing strategy changing for Medicare Part B medical specialty program, starting Dec. 7 Blue Cross and BCN require authorization for immune globulin products covered under the medical benefit for Medicare Plus Blue℠ PPO and BCN Advantage℠ members. As part of the authorization process, we’re updating our dosing strategy for intravenous and subcutaneous immune globulin therapy effective Dec. 7, 2020. For more information, see Page 11 of the September–October 2020 BCN Provider News or the September 2020 issue of The Record. We are simplifying the inquiry and appeal process Blue Cross will begin accepting your post-service claim appeal requests verbally when you contact Provider Inquiry, effective Oct. 1, 2020. You should continue to contact Provider Inquiry for any inquiry related to benefits, eligibility and claims. Facility providers should call 1-800-249-5103. Note: These changes only apply to commercial PPO appeals. BCN HMO, BCN Advantage, Medicare Plus Blue PPO, Medicare Private Fee for Service, Federal Employee Program and Blue Cross Complete plans, as well as prior authorization and clinical editing appeals, are not impacted by these changes. For more information, see the September 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 on Page 8 of the September–October 2020 BCN Provider News or the August 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. |