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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.
CQI incentive program now available for ambulatory surgery facilities We recently expanded the Collaborative Quality Initiatives program to include procedures performed at independent, free-standing ambulatory surgery facilities*. *Independent free-standing ASFs are entities that operate exclusively for the purpose of providing outpatient surgical services to patients and aren’t associated with one or more of Blue Cross Blue Shield of Michigan’s participating hospital agreements related to hospital outpatient services. Read more: Private duty nursing will soon require prior authorization Starting Oct. 1, 2022, private duty nursing agencies will be able to participate in Blue Cross Blue Shield of Michigan’s Traditional and TRUST PPO (commercial) network. Participating agencies can receive direct reimbursement for covered services within the scope of their licensure. Read more: June 2022 issue of The Record Holiday office closings Blue Cross and BCN offices will be closed June 20 (Juneteenth Day) and July 4 (Independence Day). Commercial DRG clinical validation audits will begin in August 2022 EquiClaim, an independent company that provides auditing support for Blue Care Network, will perform clinical validation and coding claim audits on inpatient hospital diagnosis related groups, or DRGs. Here are time frames for determinations on authorization requests for acute inpatient medical admissions We’ve updated the document Submitting acute inpatient authorization requests: Frequently askedquestion for providers to include information on the time frames to make a determination on authorization requests for Blue Cross and BCN acute inpatient medical admissions. Read more: Use C9399 to bill new drugs and biologicals for first year after FDA approval for Medicare Advantage members Use HCPCS code C9399 when billing for new drugs and biologicals that have been approved by the U.S. Food and Drug Administration but haven’t been assigned a specific HCPCS code. Read more: May 2022 issue of The Record Update: We’ll stop accepting faxed requests for commercial SNF admissions starting June 1 Starting June 1, 2022, skilled nursing facility prior authorization requests must be submitted through the e-referral system. Faxes will only be accepted for urgent requests when the e-referral system isn’t available. This applies to SNF requests for initial admissions and additional days for Blue Cross and BCN commercial members Read more: Blue Cross payment policy for hyperbaric oxygen therapy will align with our medical policy Claims submitted with CPT code *99183 and HCPCS code G0277 will be evaluated to ensure that they include a diagnosis code that aligns with our established medical policy. Claims that don’t contain a requisite diagnosis may receive a denial. Read more: June 2022 issue of The Record *CPT Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
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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. |