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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.
CareCentrix to manage network for independent home infusion therapy and ambulatory infusion suite providers, starting Jan. 1 Effective Jan. 1, 2022, Blue Cross Blue Shield of Michigan and Blue Care Network will delegate management of the in-state independent home infusion therapy and ambulatory infusion suite provider network to CareCentrix® for commercial members. Read more: CareCentrix monitoring home health authorizations for missing HIPPS codes for Medicare Plus Blue℠ members When submitting claims for home health care services for Medicare Plus Blue members who receive services in Michigan, you must include the CareCentrix®-assigned health insurance prospective payment system, or HIPPS, code. If the HIPPS code isn't included, then Blue Cross will reject the claim. To ensure that you have a HIPPS code when you submit claims for these members, CareCentrix monitors home health authorizations for missing HIPPS codes. Read more: Holiday office closings Blue Cross and BCN offices will be closed Nov. 25-26 (Thanksgiving). Clinical editing billing tips In most issues of BCN Provider News, we publish clinical editing billing tips. This helps ensure that Blue Cross and BCN pay your claims accurately and the performed procedure is correctly reported to us. Read more: Page 38 of the September–October 2021 BCN Provider News New method of obtaining emergency crisis assessment for psychiatric issues, treatment coming Starting Oct. 1, 2021, Blue Cross and BCN will begin covering mobile crisis and crisis stabilization services for mental health treatment. Both urgent care and crisis residential services are already covered. Note: Medicare Plus Blue members won’t be included in this new program at this time. Read more: Facility charges for daily respiratory therapy services will be prorated Blue Cross and BCN are prorating daily respiratory therapy services by hours used, not to exceed 24 hours in a single day. Providers have indicated that they’re unable to bill respiratory therapy on an hourly basis, so we’ll manually prorate the service and won’t reimburse the full charge. This applies to an inpatient setting only. Read more: New rider for large groups in the Upper Peninsula will limit coverage outside Michigan Effective Oct. 1, Blue Care Network large group plans will require a mandatory rider for group customers with locations in the Upper Peninsula. The rider will limit coverage outside Michigan to urgent, emergency or accidental services. Read more: Page 5 of the September–October 2021 BCN Provider News Providers may only bill members for applicable deductibles and copayments We want to remind providers that they must bill Blue Cross and BCN for all covered services and may only bill members for applicable deductibles and copayments. In keeping with provider contracts, you may not collect deposits or bill members upfront for unpaid balances of covered services. Read more: Contact Provider Inquiry for claims issues If you’re experiencing claims or complex claims issues, contact Provider Inquiry. If you call your provider consultant, you’ll first need a reference number from Provider Inquiry.
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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. |