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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 here for you — virtually Although we’ve been unable to meet with you in person for the last several months, Blue Cross Blue Shield of Michigan and Blue Care Network’s provider consultants continue to work hard to assist health care providers virtually. Our consultants are available to help meet your education and training needs, and to help clarify medical policy and contract information. We encourage you to use our self-service tools and Provider Inquiry when you need help with claims. When your issue still isn’t resolved, contact your consultant and provide the number given to you by the Provider Inquiry representative.
For more information, see Page 5 of the January‑February 2021 BCN Provider News or the December 2020 issue of The Record.
New clinical editing resource helps you correct billing errors We’ve posted a new billing tips resource, titled Clinical Edits: What You Need to Do and What Documentation is Needed, in the Provider Secured Services area of bcbsm.com. For more information, see Page 32 of the January–February 2021 BCN Provider News or the December 2020 issue of The Record. New billing requirements for reduced or no-cost devices Blue Cross has adopted a new medical device billing policy to align with Centers for Medicare & Medicaid Services and industry standards. There are guidelines and condition codes provided for billing for no-cost items due to recall, replacement or free samples. For more details and the list of guidelines, see the December 2020 issue of The Record. Here are requirements for submitting SNF and Flexible Benefit Option requests for FEP members Before we can process Flexible Benefit Option requests for skilled nursing facility admissions for Blue Cross and Blue Shield Federal Employee Program® Service Benefit Plan members, there are verbal or signed consents that must be obtained from members. For a detailed list of requirements, see the December 2020 issue of The Record. Know how to avoid SNF denials for Medicare Advantage claims In the fourth quarter of 2020, Blue Cross and BCN will begin denying skilled nursing facility claims when patient-driven payment model, or PDPM, levels don’t match the levels naviHealth authorized. This applies to SNF claims for Medicare Plus Blue℠ and BCN Advantage℠ members. Facilities can resubmit denied claims with the approved PDPM levels. In future communications, we’ll let you know the exact date on which we’ll begin denying claims. For more information, see the November 2020 issue of The Record. Holiday office closings Blue Cross and BCN offices will be closed Dec. 24 through 25 (Christmas), Dec. 31 through Jan. 1 and Jan. 18 (Martin Luther King Jr. Day). | |||
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |