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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. Next phase of Provider Secured Services and web-DENIS retirement announced On Sept. 15, 2022, Blue Cross Blue Shield of Michigan and Blue Care Network will conduct the second phase of retiring Provider Secured Services and web-DENIS, which will include the removal of the Internet Claims Submission Tool and some additional applications. Read more: Post-acute care providers need direct access to naviHealth’s provider portal  
The way post-acute care providers access naviHealth’s provider portal, nH Access, is changing with Blue Cross and BCN’s transition to Availity Essentials. Post-acute care providers will need direct access to nH Access. Read more: Use updated forms for post-acute care prior authorization requests for commercial members  
Providers should use our updated and aligned forms when submitting prior authorization requests for post-acute care for Blue Cross and BCN commercial members. Read more: Submit requests for commercial inpatient rehabilitation admissions and extensions only through e-referral
Beginning Jan. 1, 2023, we’ll require inpatient rehabilitation, or IPR, providers located in Michigan to submit prior authorization requests through the e-referral system and not by fax. This applies to requests for both Blue Cross and Blue Care Network commercial members for:
Read more: New lab program for Blue Cross commercial and Medicare Plus Blue now live
Blue Cross has instituted a new laboratory benefits management program supported by Avalon Healthcare Solutions, an independent company. This program uses enhanced editing to promote correct coding and assist with accurate claim payment. Read more: September 2022 issue of The Record Benefit Explainer includes new payability limitation
Benefit Explainer users may have started seeing a new payability limitation regarding the National Provider Identifier, beginning Aug. 1, 2022. The new limitation can appear as a stand-alone rule or as a combination rule with another limitation. Read more: September 2022 issue of The Record Here are updated guidelines for billing self-administered medications provided in outpatient facilities
When a Medicare Advantage member is receiving services in an outpatient facility but hasn’t brought their self-administered medications with them, follow the updated guidelines for what to do and what not to do. Read more: Reminder: Only certain modifiers payable for services provided in OPC facilities for Blue Cross commercial members
When billing for services provided in an outpatient psychiatric care facility, include the appropriate modifier to identify the licensure level of the servicing provider. Read more: September 2022 issue of The Record Reminder: Private duty nursing services will require prior authorization
Agencies will need to get prior authorization before providing private duty nursing services for dates of service on or after Oct. 1, 2022. We began accepting prior authorization requests for these services through the e-referral system on Sept. 1. Read more: September 2022 issue of The Record 2023 ICD-10-CM and PCS code updates available Fiscal year 2023 ICD-10-CM and ICD-10-PCS code updates, which will be effective with dates of service on and after Oct. 1, 2022, are now available. Read more: September 2022 issue of The Record DRG clinical validation audits will begin in September for Medicare Plus Blue claims
Beginning September 2022, EXL, an independent company that provides auditing support for Blue Cross, will perform clinical validation and coding claim audits for Medicare Plus Blue℠ claims on inpatient hospital diagnosis related groups, or DRGs. Read more: August 2022 issue of The Record CS modifier limited to specific codes, effective Sept. 1
Blue Cross and Blue Care Network commercial plans are limiting the use of the CS modifier to a specific list of codes effective for dates of service on or after Sept. 1, 2022. Read more: August 2022 issue of The Record Holiday office closings Blue Cross and BCN offices will be closed Nov. 8 (Election Day) and Nov. 24-25 (Thanksgiving).
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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. |