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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.
TurningPoint musculoskeletal program enhancements New enhancements have been made to the TurningPoint Healthcare Solutions musculoskeletal surgical quality and safety management program. For a complete listing, see Page 26 of the July–August 2021 BCN Provider News or the July 2021 issue of The Record. Timely clinical information is key to receiving faster responses on authorization requests We’re working to improve our response times and ask for your help to prevent your authorization request from being delayed or denied. It’s important that providers respond quickly to requests for documentation to prevent a delay of necessary or urgent medical services for members. For more information, see Page 4 of the July–August 2021 BCN Provider News or the July 2021 issue of The Record. Choose the correct servicing provider in e-referral to avoid denied claims To avoid issues or denied claims when you are submitting authorizations and referrals in e-referral, we’ve clarified the steps you should take to make sure you’ve selected the correct servicing provider. For more information, see Page 30 of the July–August 2021 BCN Provider News or the July 2021 issue of The Record. ClaimsXten™ to include additional edits ClaimsXten will edit additional services for professional and outpatient providers, starting in October 2021. These new edits will promote correct coding and enhance our claims payment systems. For more information, see the July 2021 issue of The Record. 2021 InterQual® criteria Blue Cross Blue Shield of Michigan and Blue Care Network will use 2021 InterQual criteria to make authorization request determinations for behavioral and non-behavioral health services, starting Aug. 2, 2021. (For Blue Cross commercial member behavioral health authorization requests, New Directions uses its own criteria for making determinations.) For more information, see Page 9 of the July–August 2021 BCN Provider News (non‑behavioral health services), Page 13 of the July–August 2021 BCN Provider News (behavioral health services) or the July 2021 issue of The Record. Procedure codes *70554 and *70555 to require prior authorization from AIM starting Sept. 1 for Blue Cross commercial and Medicare Plus Blue℠ members For dates of service on or after Sept. 1, 2021, the services associated with radiology codes *70554 and *70555 will require prior authorization from AIM Specialty Health®. Read more in the June 2021 ereferrals.bcbsm.com news item. *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved. Reminder: Here’s how to find help You’re trying to get your work done and you run into a Blue Cross Blue Shield of Michigan or Blue Care Network question or problem that you need to solve. Where do you turn? For instructions on getting help online, with Provider Inquiry or your provider consultant, see Page 3 of the January–February 2020 BCN Provider News or the January 2020 issue of The Record. Training updates New provider training site Active training courses and materials from 2019-2021 have moved from BCBSM Provider Training and BCN Learning Opportunities to the new training site. For more information, see Page 5 of the July–August 2021 BCN Provider News or the July 2021 issue of The Record. New on-demand training available Lunch and learn webinars for physicians and coders focus on risk adjustment, coding | |
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |