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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.
Holiday office closings Blue Cross and BCN offices will be closed Monday, July 5 (Independence Day). Reminder: eviCore will no longer mail Practice Profile summaries and category information for outpatient PT services starting in July Beginning with July 2021 data, eviCore will no longer mail paper copies of the Practice Profile Summary, which includes information about your assigned category, to health care providers. Instead, eviCore will post category updates on the first business day of February and August each year beginning Aug. 2, 2021. Read more in the June 2021 issue of The Record. CareCentrix to manage authorizations for home health care for Medicare Advantage members Blue Cross Blue Shield of Michigan and Blue Care Network have contracted with CareCentrix® to manage the authorization of home health care for Medicare Advantage members. For episodes of care starting on or after June 1, 2021, providers will need to request prior authorization from CareCentrix for Medicare Plus Blue℠ and BCN Advantage℠ members. For more information, see Page 17 of the May–June 2021 BCN Provider News or the May 2021 issue of The Record. RC Claim Assist update Starting May 1, 2021, you must go through Provider Secured Services to access RC Claim Assist. For more information, see Page 32 of the May–June 2021 BCN Provider News or the May 2021 issue of The Record. Revised Participating Hospital Agreement takes effect July 1 The Health Care Delivery Committee, a committee of the Blue Cross Blue Shield of Michigan Board of Directors, approved the Third Amended and Restated Participating Hospital Agreement earlier this year. A copy of the new PHA was sent to all participating hospitals and becomes effective on the first day of the participating hospitals’ fiscal year, beginning on or after July 1, 2021. For more details, see the June 2021 issue of The Record. Starting in August, Michigan outpatient facilities must bill NDCs with NOCs or commercial claims will reject Starting Aug. 1, 2021, when outpatient facilities bill for drugs for Blue Cross commercial members on an outpatient claim with a HCPCS code that has a not otherwise classified code, they must also include the National Drug Code. HCPCS codes for NOC drugs billed without this information will be rejected. For more details, see Page 18 of the July–August 2021 BCN Provider News or the May 2021 issue of The Record. Qualified providers invited to apply for designation in BDC Substance Use Treatment program Qualified facility providers are urged to apply for national designation as a Blue Distinction® Center for Substance Use Treatment and Recovery. This is the newest BDC designation. It recognizes providers that have demonstrated expertise in delivering quality specialty care in this area safely, effectively and cost efficiently. For more information, see Page 1 of the May–June 2021 BCN Provider News or the May 2021 issue of The Record. Here are requirements for submitting Flexible Benefit Option and SNF admission requests for FEP members Before we can process Flexible Benefit Option requests for Blue Cross and Blue Shield Federal Employee Program® Service Benefit Plan members, including those for skilled nursing facility admissions or extensions, Blue Cross must receive a membersigned Alternative Benefit Agreement and a verbal or signed consent for Blue Cross Coordinated Care. To learn more about the Flexible Benefit Option and how to submit a request, see the June 2021 issue of The Record. Save time: Don’t fax unnecessary information about inpatient stays We’re receiving faxes related to inpatient stays from hospital utilization review departments and most of these faxes aren’t required. To help you save time and get the information to the right place, see the type of information and how to send it in the on Page 40 of the May–June 2021 BCN Provider News or the May 2021 issue of The Record.
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Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |