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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. BCN offers incentive for PCPs who provide in-person care for BCN Virtual Primary Care patients Starting with dates of service May 1, 2023, Blue Care Network is offering an incentive for BCN primary care providers who agree to see an adult member (age 18 and older) in their office who is enrolled in BCN Virtual Primary Care℠ HMO or Blue Cross® Preferred HMO Virtual Primary Care, and for whom the BCN network PCP has received a referral: We’ll use 2023 InterQual criteria starting Aug. 1 Blue Cross Blue Shield of Michigan and Blue Care Network will start using 2023 InterQual® criteria on Aug. 1, 2023, to make determinations on prior authorization requests for the behavioral health and non-behavioral health services we manage. Read more: Carelon to expand existing prior authorization starting Sept. 1 For dates of service on or after Sept. 1, 2023, additional services will require prior authorization by Carelon Medical Benefits Management (formerly known as AIM Specialty Health®. Read more: July 2023 issue of The Record Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services Holiday office closings Blue Cross and BCN offices will be closed July 3 to 4 (Independence Day). Submit prior authorization requests for ABA services through e‑referral Beginning June 1, 2023, licensed behavior analysts, or LBAs, in Michigan must submit prior authorization requests for applied behavior analysis, or ABA, services through the e‑referral system. This affects LBAs who provide ABA services to BCN commercial members. Read more: Page 12 of the July–August 2023 BCN Provider News Starting June 1, requests for commercial LTACH admissions and extensions must be submitted through e-referral On June 1, 2023, we began requiring long-term acute care hospitals in Michigan to submit prior authorization requests through the e-referral system and not by fax. Read more: Submit prior authorization requests for human organ transplants through e-referral, not fax, starting June 1 On June 1, 2023, we began requiring providers located in Michigan to submit prior authorization requests for human organ transplant procedures through the e-referral system and not by fax. Read more: Reminders: Our affiliation agreements and our concierge medicine policy Health care providers who offer concierge medicine must comply with their affiliation agreements to submit claims for covered services directly to Blue Cross, accept our payment for covered services as payment in full, only charge the member the applicable copay or deductible (or both) for the covered service, and avoid discriminating against members based on payment level, benefit or reimbursement policies. Read more: July 2023 issue of The Record Reminder: Only charge patients their cost share When you treat a patient with Blue Cross or BCN coverage, including Medicare Plus Blue℠ or BCN Advantage℠, be sure to bill Blue Cross or BCN for covered services and only charge the member the appropriate cost share according to their health plan coverage. Read more: Behavioral health providers: How to bill prolonged services In January 2023, 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 by the American Medical Association as of Jan. 1, 2023. Read more: *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2022 American Medical Association. All rights reserved. Help patients avoid being balance billed by noncontracted ambulance services As a reminder, providers must order transfers from Blue Cross and BCN-contracted ambulance services when arranging for non-emergency ground transfers to prevent patients from being balanced billed large amounts from noncontracted ambulance services. Read more: Blue Cross begins using Quartet to help connect members with behavioral health providers Blue Cross is now using Quartet, an independent company, to assist members seeking outpatient care for mental health or substance use disorders. Effective July 1, 2023, Quartet will begin referring eligible members seeking outpatient treatment to behavioral health providers registered on Quartet’s online platform, based on their clinical specialty and their availability. Read more:
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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. |