Blues Brief

Download a printable version to read or shareFebruary 2023

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.

Follow these tips for checking claim status and viewing remittance advices and vouchers in Availity

To get started checking eligibility and benefits on our new provider portal, Availity^® Essentials, simply click on Patient Registration at the top of your Availity home screen. Then select Eligibility and Benefits Inquiry.

Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services.

Reminder: HEDIS^® medical record reviews begin in February

Each year from February through May, Blue Cross Blue Shield of Michigan conducts 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 members who had services in 2022.

HEDIS^®, which stands for Healthcare Effectiveness Data Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA.

For Blue Cross commercial members, follow ICD-10-CM laterality policy

In support of correct coding and payment accuracy, Blue Cross Blue Shield of Michigan commercial plans will apply the ICD-10-CM laterality policy for diagnosis-to-modifier comparison and diagnosis-to-diagnosis comparison. This change will take effect in March 2023.

Reminder: Submit Healthy Blue Living℠ HMO qualification forms electronically

As a reminder, primary care physicians submitting the Blue Care Network Qualification Form for Blue Care Network members with health care coverage from Healthy Blue Living℠ HMO, Healthy Blue Living HMO Basic℠ or BCN Wellness Rewards Tracking℠ must do so electronically through BCN Health e-Blue℠. BCN doesn’t accept paper qualification forms.

Read more: Jan. 11, 2023 provider alert

Billing for visits
BCN will pay primary care physicians $40 (per member per year) for each qualification form submitted on Health e-Blue. You must file a claim with BCN for the examination to receive reimbursement for completing members’ qualification forms. Claims for completing the form should be billed in the amount of $40 using the CPT code *99080 and the diagnosis code is Z00.00 or Z00.01 For a detailed description of this process, review the Billing instructions: Visits and forms for Healthy Blue Living HMO, Healthy Blue Living HMO Basic and BCN Wellness Rewards Tracking for BCN HMO (commercial) PDF available on the Provider Resources site, accessible through our provider portal. Click BCN on the Products drop-down menu.

Voluntary prior authorization ends May 1

Effective May 1, 2023, Blue Cross Blue Shield of Michigan will no longer accept voluntary prior authorization requests. Due to new Michigan prior authorization legislation requirements, Blue Cross will devote its resources to evaluating only those prior authorizations that are required by the patient’s benefit plan.

2023 Quality Rewards program announced

Blue Cross and BCN have posted the 2023 Quality Rewards program booklet in the Resources section of Health e-Blue℠. The Quality Rewards program is Blue Cross and BCN’s Performance Recognition Program and Physician Group Incentive Programs combined.

Health care providers in Blueprint for Affordability shared-risk program improve performance

Nearly three years after the launch of the Blueprint for Affordability shared-risk payment model, we’re seeing some impressive results. Physicians in Blueprint arrangements improved affordability by more than $70 million, increased overall health care quality and improved patient outcomes.

2023 CPT and HCPCS Update now available

Each year, we publish our CPT and HCPCS Update document, containing new and deleted CPT and HCPCS codes, and post it on the Provider Resources site of Availity^®. Our new document contains new and deleted codes, effective Jan. 1, 2023.

Training updates

Rx updates

We’re no longer requiring prior authorization for 29 medical oncology drugs

Requirements changed for some commercial medical benefit drugs

Fylnetra and Rolvedon to require prior authorization for most commercial members starting March 13

Finding the latest coronavirus (COVID-19) provider information

Our provider communications about COVID-19 can be found here:

In the Member Care section of our secure Provider Resources site, accessible through Availity^®
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.