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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. Reminder: When to use a global referral, plan notification or authorization Global referral: For Blue Care Network commercial members with a primary care physician in the East or Southeast region. The PCP must submit the global referral. Outside those regions, chiropractors must submit a plan notification. Use the Submit Referral option in e‑referral. Plan notification: For members with BCN Advantage℠ HMO-POS and BCN Advantage℠ HMO products. A plan notification alerts BCN to a scheduled service and is used for claims processing purposes. Use the Submit Referral option in e‑referral. Global referral and plan notification information can be found in the chiropractic services section on Page 2 of the BCN Referral and Authorization Requirements (PDF). Authorization: For Blue Cross commercial, Medicare Plus Blue℠, Blue Care Network commercial and BCN Advantage members. For procedures and services that require authorization, see the Chiropractic services and Physical, occupational and speech therapy with an autism diagnosis sections of the Summary of utilization management programs for Michigan providers (PDF) or the Utilization Management chapter of the BCN Provider Manual. We’re covering acupuncture for Medicare Advantage members Retroactive to Jan. 21, 2020, Medicare Plus Blue and BCN Advantage members have coverage for acupuncture to treat chronic low back pain, or cLBP. We cover up to 12 visits in 90 days for qualifying patients who’ve had chronic low back pain. For more details, see Page 15 of the November–December 2020 BCN Provider News or the October 2020 issue of The Record. We won’t be re‑tiering our chiropractic commercial network again this year To help monitor and control the cost of chiropractic care, we work with Optum®, a company that assists us and our health care providers in promoting appropriate utilization in our Blue Cross commercial chiropractic network. Due to a change in how chiropractor data between Blue Cross and Optum® is exchanged, there’s been a delay in posting updated profiling data to the Optum provider website.** As a result, we won’t be re‑tiering our commercial chiropractic network based on July 1, 2019, to June 30, 2020, data. **Blue Cross Blue Shield of Michigan doesn’t own or control this website. TurningPoint musculoskeletal authorization program to expand in January TurningPoint Healthcare Solutions is expanding its surgical quality and safety management program for Blue Cross and BCN members. See Page 36 of the January ‑February 2021 BCN Provider News or the November 2020 issue of The Record for information about:
Benefit period extended for authorized PT, OT and ST for BCN HMO (commercial) members during COVID-19 emergency Effective Aug. 28, 2020, the benefit period for completing authorized physical, occupational and speech therapy (and physical medicine services by chiropractors) has been extended to 270 days for BCN HMO members whose plans normally have a 60‑consecutive‑day benefit. The benefit period starts on the date of the first treatment. The extended therapy benefit period will continue until further notice. For more information, see Page 50 of the November‑December 2020 BCN Provider News. Educating patients about low back pain Evidence has shown that unnecessary or routine imaging, such as X‑rays, MRIs and CT scans for low back pain, isn’t associated with improved outcomes. Avoidable imaging can put patients at risk of unnecessary treatments, surgeries and radiation exposure. To assist providers, the Michigan Quality Improvement Consortium routinely updates guidelines for assessment, diagnosis and treatment of low back pain. To find out how you can educate your patients, see 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. 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. |