Blues Brief

Download a printable version to read or shareMay 2022

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.

Transition to Availity

Notice: Last day for Provider Secured Services and web-DENIS is June 21

Blue Cross Blue Shield of Michigan and Blue Care Network’s Provider Secured Services and web-DENIS will have their last day of operation on June 21. Beginning June 22, these tools will no longer be available.

Blue Cross Commercial Provider Manual has moved to our new provider portal

The Blue Cross Commercial Provider Manual has moved from Benefit Explainer to our new provider portal, Availity℠.

Designate Availity administrator and ensure access to e-referral and Health e-Blue within Availity

Your Availity^® administrator needs to take action to set up access to e-referral and (if appropriate) Health e-Blue℠. This will ensure users can access these tools through Availity Essentials.

New Secure Provider Resources site

Information you used to find on either the BCBSM Newsletters and Resources or the BCN Provider Publications and Resources sections of web-DENIS are now combined into a single location, the Secure Provider Resources website.

SecureCare^® to manage certain services

Blue Cross has contracted with SecureCare^®, an independent network performance management company, to manage outpatient PT, OT, ST, physical medicine and chiropractic services for Blue Cross commercial and Medicare Plus Blue℠ members starting July 5.

Providers in East, Mid and Southeast regions have a new email box to reach provider consultants

Blue Cross and BCN want to make it easier and simpler for you to reach a provider consultant when you need to escalate a provider inquiry. To this end, providers in the East, Mid and Southeast regions now have a new email box to use: petcontactus@bcbsm.com.

Star tip sheets updated for 2022

We recently updated our Medicare Star Ratings tip sheets for 2022 and posted them in the member care section of Secure Provider Resources on Availity.

Reminder: You’ll receive a clinical edit for vitamin D testing when it doesn’t meet CMS criteria

As a reminder, BCN implemented a clinical edit effective July 1, 2021, related to vitamin D testing. This edit is in accordance with the Centers for Medicare ∓ Medicaid Services.

Holiday office closings

Blue Cross and BCN offices will be closed May 30 (Memorial Day).

Training updates

Lunch and learn webinars for physicians and coders focus on risk adjustment, coding

Virtual provider symposiums to focus on patient experience, HEDIS

Virtual provider symposiums to focus on documentation and coding

Rx updates

Members can get Nonopioid Directive form on our website

Carvykti requires prior authorization for Medicare Advantage members

Danyelza, Margenza and Saphnelo to require prior authorization for URMBT members with Blue Cross non-Medicare plans

Brineura won’t require prior authorization for URMBT members with Blue Cross non-Medicare plans

Empaveli, Actemra to require prior authorization for Blue Cross URMBT non-Medicare members

Blue Cross, BCN covering additional vaccines

Kimmtrak, Tivdak to require prior authorization for most members

We’re providing purchasing and billing information for Spravato

Finding the latest coronavirus (COVID-19) provider information

Our provider communications about the COVID-19 pandemic can be found on the Coronavirus (COVID-19) information updates for providers webpage located within BCBSM Newsletters and Resources or BCN Provider Publications and Resources on web-DENIS. Our public webpage for providers is located at bcbsm.com/coronavirus. Click on Health Care Providers.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.