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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 global referrals through at least Dec. 31 for BCN HMO members Blue Care Network is implementing another utilization management change aimed at supporting our providers during the COVID-19 emergency. Here’s what’s changing for global referrals submitted for BCN HMOSM (commercial) members on or after March 13, 2020:
For more information, see Page 29 of the September–October 2020 BCN Provider News. 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 impacted, 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. Use our online resources to understand billing guidelines BCN provides an array of clinical editing and billing resources to help providers bill to avoid clinical edits or denials. Online resources can help you understand how a claim may process. For more information, see Page 28 of the September–October 2020 BCN Provider News. We’re temporarily allowing direct-line ABA interventions to be performed via telemedicine Until further notice, we’re temporarily allowing providers to perform direct-line ABA interventions (CPT code *97153) through telemedicine for dates of service on or after Aug. 3, 2020. For more information on updated documents available regarding member benefits, checking eligibility, and authorization requirements, see Page 18 of the September–October 2020 BCN Provider News or the September 2020 issue of The Record. *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved. Holiday office closings Blue Cross and BCN offices will be closed on Sept. 7 for Labor Day. Oncology management program to include Blue Cross commercial members Beginning Dec. 1, 2020, Blue Cross Blue Shield of Michigan 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. We are simplifying the inquiry and appeal process Blue Cross Blue Shield of Michigan will begin accepting your claim appeal verbally when you contact Provider Relations & Servicing, effective Oct. 1, 2020. You should continue to contact PRS for any inquiry related to benefits, eligibility and claims. For medical providers: 1-800-344-8525 For more information, see the September 2020 issue of The Record. AllianceRx Walgreens Prime PPO 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. 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. We’re revising our policy on hypofractionation for breast and prostate cancer Blue Cross and BCN have revised the radiation oncology program, managed through eviCore healthcare, to limit coverage for many breast and prostate cancers to hypofractionation, a shorter, equally effective regimen. This applies to requests submitted on or after Sept. 21, 2020. The new policy applies to Blue Cross commercial, Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM. It doesn’t apply to Blue Cross self‑funded groups. For more information including how to submit authorization requests, see Page 4 of the September–October 2020 BCN Provider News or 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 BlueSM PPO and BCN AdvantageSM 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. | |
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |