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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. Reminder: Prior authorization changes went into effect June 1 Michigan’s prior authorization law requirements went into effect on June 1, 2023. These requirements apply to health care insurers and providers in Michigan for members who have commercial coverage. Read more: Some pre-COVID-19 utilization management requirements to resume July 1 With the end of the COVID-19 public health emergency, Blue Cross Blue Shield of Michigan and Blue Care Network reinstated certain utilization management requirements that were in effect before the PHE. Read more: June 2023 issue of The Record MAPS may not capture all information about a patient’s experience with controlled substances Health care providers using the Michigan Automated Prescription System should know that the database may not capture information about some controlled substances in a patient’s history. Read more: June 2023 issue of The Record Don’t miss important Blue Cross and BCN news You’re invited to subscribe to any of our electronic newsletters that help inform health care professionals about Blue Cross and BCN policies and programs. Visit bcbsm.com/providers/newsletters.html to view current issues and sign up to receive emails as new issues are posted. Providers to receive denial for incorrect coding of electroencephalogram and ultrasound screening for abdominal aortic aneurysm, starting in September Providers need to code correctly for electroencephalogram and abdominal aortic aneurysm screening to avoid a claim denial. Read more: June 2023 issue of The Record Starting June 1, requests for commercial LTACH admissions and extensions must be submitted through e-referral Long-term acute care hospitals in Michigan must submit prior authorization requests through the e-referral system and not by fax, starting June 1, 2023. Read more: Submit prior authorization requests for human organ transplants through e-referral, not fax, starting June 1 Starting July 1, 2023, Blue Cross and BCN will use the Audaire Health™ provider portal to track and capture clinical outcomes for CAR-T cell therapy drugs for Blue Cross commercial and BCN commercial members. Read more: Blue Cross expanding covered services for substance use disorders and mental health Effective July 1, 2023, we’ll cover the following as standard benefits for all Blue Cross commercial members:
Read more: May 2023 issue of The Record Reminder: Outpatient services provided during inpatient admission should be reported with inpatient claim In May 2023, Blue Cross payment policy began requiring that outpatient services provided during an inpatient admission be reported with the inpatient claim if there is a similar diagnosis. Read more: May 2023 issue of The Record Behavioral health providers: How to bill prolonged services In January 2023, we posted a provider alert in which we asked behavioral health providers to hold claims for dates of service on or after Jan. 1, 2023, that contain procedure codes *99354 and *99355. These codes were for prolonged services and were terminated as of Jan. 1, 2023. Learn what to do with the claims that you’ve been holding. Read more: May 17, 2023 provider alert *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2022 American Medical Association. All rights reserved. EDI transitioning to Availity starting in 2023 Blue Cross and BCN will move our electronic data interchange services, known as EDI, to Availity® beginning in August 2023. The EDI transition affects HIPAA* electronic transactions. Read more: *Health Insurance Portability and Accountability Act Here’s how to determine prior authorization requirements for patients with non-Michigan Blue plans Michigan providers can find information about prior authorization requirements for patients with nonMichigan Blue plans as follows:
Read more: April 2023 issue of The Record Holiday office closings Blue Cross and BCN offices will be closed July 3 to 4 (Independence Day). Finding the latest coronavirus (COVID-19) provider information
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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. |