October 2014

Here’s what you need to know about our PPO program policies and members’ rights, responsibilities
We want to ensure that you understand the following about our preferred provider organization plans and programs... Read more.

Inside this issue for you

• 3.6 million Blue Cross members now receive EOBs in easy-to-understand format
• Timely responses are important as medical record reviews continue through 2014

See all the articles in this issue, grouped by category, below. Click on the headlines to read the articles you’re interested in or to print them. If you need to print all the articles in this issue, click here.

• Here’s what you need to know about our PPO program policies and members’ rights, responsibilities
• 3.6 million Blue Cross members now receive EOBs in easy-to-understand format
• Timely responses are important as medical record reviews continue through 2014
• Register today for live webinars on Oct. 15, 29 and Nov. 5
• Use of Groupon^® prohibited by terms of participation agreements
• BlueCard^® program offers plenty of support options for provider community
• Keep these coding tips in mind to improve medical record documentation
• HCPCS codes added
• Prescription drug lists updated, check our website
• Reminder: Payment decisions require supporting documentation
• Reminder: Preauthorization for abdomen and pelvis CT scans
• Blues highlight medical, benefit policy changes
• Navigating the electronic Record

• Enrollment for BCBSM’s and BCN’s new freestanding radiology center networks begins on Oct. 1
• Preauthorization required for in-lab sleep studies
• Blue Cross’ PPO Radiology Management Program expands to include echocardiography services
• BCBSM 101 training class available for new professional billing staff and others looking for a refresher
• Reminder: Blues to retire Facility and Provider Claims Correction tool
• Updates to Medical Drug Prior Authorization Program take place Jan. 1

• 2014 Blues Medicare Advantage Performance Recognition Program updated
• Reminder: Conduct patient visits by year-end to close diagnosis gaps for 2014 incentive

• Enrollment for BCBSM’s and BCN’s new freestanding radiology center networks begins on Oct. 1
• Blue Cross’ PPO Radiology Management Program expands to include echocardiography services
• We’re shutting down the Exception Admission application on web-DENIS
• Reminder: Hospitals must follow claims appeals process in provider manual
• Reminder: Blues to retire Facility and Provider Claims Correction tool

• Updates to Medical Drug Prior Authorization Program take place Jan. 1
• Are you billing correctly for these drugs?

• Blue Cross to manage non-Medicare durable medical equipment benefits for MPSERS members

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.