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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.
Outpatient PT, OT services no longer require prior authorization for Medicare Plus Blue starting April 1 For dates of service on or after April 1, 2022, Medicare Plus Blue will no longer require prior authorization for outpatient physical and occupational therapy services. Read more: March 2022 news item on ereferrals.bcbsm.com Outpatient facilities must bill self-administered medications through Medicare Part D If Medicare Advantage members don’t bring their self-administered medications with them when receiving services at an outpatient facility, the facility should obtain the medications through its onsite ambulatory pharmacy, if one is available. Read more: Feb. 24 web-DENIS message Our move to Availity in 2022 Timeline for our transition to the Availity provider portal:
You’ll soon receive an email from Blue Cross Blue Shield of Michigan with a special edition newsletter focused on Blue Cross and Blue Care Network’s transition to our new provider portal. The special edition will help you learn about our new portal, including information on registration and training. Read more: Musculoskeletal procedure authorizations: Reminders for facilities We've published several reminders when changing the place of service from outpatient to inpatient for musculoskeletal surgical and related procedures that require authorization from TurningPoint Healthcare Solutions LLC. Use the Criteria request form to obtain criteria used in making a specific determination When you submit an authorization request, we use medical necessity criteria to make a determination. To obtain the criteria we used on a specific request, you must complete the Criteria request form. Read more: March 2022 issue of The Record TurningPoint authorizations for musculoskeletal surgical and related procedures are valid for six months Prior authorization requests approved by TurningPoint Healthcare Solutions LLC on or after Jan. 1, 2022, are valid for six months from the planned date of service for all outpatient musculoskeletal procedures, including pain management procedures. Update: DRG Readmission Processing implementation In a December Record article, we wrote about proposed enhancements to Diagnosis Related Group Readmission Processing and asked for facility input. Based on that input, we’ve provided some additional information. Read more: March 2022 issue of The Record Optum to perform outpatient facility audits on Blue Cross commercial claims starting in March 2022 Optum, an independent company that provides auditing support for Blue Cross Blue Shield of Michigan, will perform audits on outpatient facility claims for Blue Cross commercial members, beginning in March 2022. Read more: March 2022 issue of The Record We’re providing more information on aligning local rules for acute inpatient medical admissions As part of our ongoing communications on what we’re doing to align local rules for acute inpatient medical admissions of members with certain conditions who are admitted on or after March 1, we recently published a new document titled Submitting acute inpatient authorization requests: Frequently asked questions for providers. Read more: Medicare Advantage post-acute care: New 30-day limit on documents in naviHealth portal Documents for Medicare Plus Blue℠ PPO and BCN Advantage℠ members are available within naviHealth’s nH Access™ portal for only 30 days from the day they were posted. This was effective Feb. 11, 2022. Read more: Ambulatory surgical centers can bill revenue code 0750 for surgical and nonsurgical related services Ambulatory surgical facilities and centers can bill revenue code 0750 for surgical and nonsurgical related services for Blue Cross members. 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. |