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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.
New and updated preview questionnaires and medical necessity criteria for the prior authorization program expansion In preparation for the upcoming expansion of the prior authorization program for Medicare Plus Blue℠, BCN commercial and BCN Advantage℠ members, we’ve added and updated preview questionnaires, authorization criteria and medical policies. These documents apply to authorization requests submitted for dates of service on or after Jan. 1, 2022. Gastric stimulation, varicose vein questionnaires updated in e‑referral system On Dec. 19, 2021, we updated the Gastric stimulation and Varicose vein treatment questionnaires in our e-referral system. Read more: February 2022 issue of The Record Advantages of using the e-referral system instead of calling or faxing for prior authorization requests Using the e-referral system is the most efficient way to submit a prior authorization request for services managed by the Blue Cross Blue Shield of Michigan and Blue Care Network Utilization Management departments. It’s also the easiest way to check the status of a request you’ve submitted. Learn more about the benefits of submitting or checking the status of a request via e-referral in the February 2022 issue of The Record. Changes to musculoskeletal procedure codes that require authorization through TurningPoint We’ve updated the Musculoskeletal procedure codes that require authorization by TurningPoint list to reflect procedure code changes that will no longer require authorization (for dates of service on or after Jan. 1, 2022), and additional procedure codes that will require prior authorization (for dates of service on or after March 27, 2022). Read more: February 2022 issue of The Record HEDIS medical record reviews begin in February Each year from February through May, Blue Cross and BCN conduct Healthcare Effectiveness Data and Information Set®, or HEDIS®, medical record reviews for members who live in Michigan. This year, Blue Cross’ HEDIS clinical consultants will conduct HEDIS reviews for services rendered in 2021 for members with Blue Cross commercial, BCN commercial, Medicare Plus Blue, BCN Advantage and individual products. Read more: February 2022 issue of The Record HEDIS 2021 results HEDIS is the most widely used set of performance measures in the managed care industry and is used by the National Committee for Quality Assurance for accreditation. Despite continued challenges related to COVID-19 and the Delta variant, HEDIS performance remains strong. BCN noted several areas of improvement in 2021 (measurement year 2020) across all lines of business. Read more: Page 13 of the January–February 2022 BCN Provider News *HEDIS, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance. 2022 transplant benefit changes for FEP members Effective Jan. 1, 2022, kidney transplants for Standard and Basic Option Federal Employee Program® members require prior authorization and are part of the Blue Distinction® Center for Transplants program. Pancreas transplants are no longer part of the BDCT program but prior authorization is still required. Read more: February 2022 issue of The Record
Rx updates Ryplazim requires prior authorization for Medicare Advantage members Read more: February 2022 issue of The Record Changes coming to preferred products for pegfilgrastim for commercial and Medicare Advantage members, starting April 1 Read more: February 2022 issue of The Record Drugs to require prior authorization for Blue Cross URMBT non-Medicare members, starting March 10 Read more: February 2022 issue of The Record | ||
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |