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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.
Clinical information will be used to validate answers in e-referral Beginning June 2021, we’ll pend some authorization requests that would usually be auto-approved based on responses to questionnaires in the e-referral system. We’ll review and verify that the clinical information provided supports your responses to the questionnaire and make a determination on the request. For more information, see Page 36 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. 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 the May 2021 issue of The Record. Holiday office closings Blue Cross and BCN offices will be closed Monday, July 5 (Independence Day). Billing policy and guidelines for intensity modulated radiation therapy When billing for intensity modulated radiation therapy, or IMRT, follow the guidelines in accordance with the new Blue Cross Blue Shield of Michigan policy. This policy has been adopted to align billing requirements with industry and Centers for Medicare & Medicaid Services standards. For more information about the IMRT policy and guidelines, see Page 34 of the May–June 2021 BCN Provider News or the April 2021 issue of The Record. Recommendations for submitting authorization requests for medical oncology drugs to AIM Follow these recommendations for submitting authorization requests for medical oncology drugs to AIM Specialty Health to ensure a more efficient authorization review process:
This information applies to all Blue Cross PPO, Medicare Plus Blue℠ PPO, BCN HMO℠ and BCN Advantage℠ members whose plans require authorization of medical oncology drugs by AIM. For more information, see Page 27 of the July–August 2020 BCN Provider News or the June 2020 issue of The Record. Oncology Provider Resources Located on ereferrals.bcbsm.com: Located on bcbsm.com/providers:
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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. |