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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. Follow these tips for checking claim status and viewing remittance advices and vouchers in Availity If you’re still getting accustomed to using our new provider portal, Availity® Essentials, we have some tips that can help with claims-related activities. Read more: Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services. We’ve updated fax forms for submitting prior authorization requests to TurningPoint On Nov. 22, 2022, Blue Cross and Blue Care Network posted updated fax forms on ereferrals.bcbsm.com for use when submitting prior authorization requests to TurningPoint Healthcare Solutions, LLC. Read more: January 2023 issue of The Record 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. Read more: Page 7 of the January–February 2023 BCN Provider News HEDIS®, which stands for Healthcare Effectiveness Data Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA. Reminder: Health e-Blue℠ data entry due soon The deadline for entering data in Health e-Blue for 2022 gaps in care is midnight Jan. 22, 2023. Data entered after this deadline won’t count for 2022 incentives. The deadline for submitting electronic medical record files is Feb. 3, 2023. Changes effective Jan. 1, 2023 See the December issue of Blues Brief for physician offices for a list of changes in effect Jan. 1. New radiology-focused initiative Blue Cross and Blue Care Network are engaging Covera Health to launch a radiology-focused quality improvement program to help us better support radiologists and referring providers. Read more: User guide created to assist providers with importing medical records EXL Health has created a user guide to assist providers with importing medical records into their portal. Providers, hospitals and facilities don’t need to register for an account to use the portal. Read more: January 2023 issue of The Record Know how to access and use RC Claim Assist RC Claim Assist is available to Blue Cross and Blue Care Network contracted providers through Availity® Essentials to help them bill for drugs covered under the medical benefit. Read more: January 2023 issue of The Record Find out more about the new Blue Cross® Local HMO and BCN Advantage℠ Local HMO As previously announced, Blue Cross Local HMO and BCN Advantage Local HMO are new products that are part of a new 2023 Local network available to Michigan residents in Macomb, Oakland and Wayne counties. Members must select a primary care physician within the Local network of physicians and hospitals affiliated primarily with Ascension and Trinity Health. Read more: Page 10 of the January–February 2023 BCN Provider News Updated tools available We’ve updated several flyers to assist you with your Blue Cross and BCN patients:
*Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website. Holiday office closings Blue Cross and BCN offices will be closed Jan. 16 (Martin Luther King, Jr. Day). Members enrolled in Healthy Blue Choices POS℠ don’t need referrals Healthy Blue Choices POS℠ is a new point-ofservice product that works similarly to our popular Blue Elect Plus℠ POS plan. Healthy Blue Choices members don’t need a referral for any covered service. They can refer themselves to any provider — even those considered out of network for this product. Read more: January 2023 issue of The Record We’ve updated Benefit Explainer to include Medicare Plus Blue benefit information On Nov. 7, 2022, we added a new link and tab in Benefit Explainer to access the same medical and benefit policy information for Medicare Plus Blue℠ members as you already had for our Blue Cross commercial members. Read more: January 2023 issue of The Record
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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. |