Medical, benefit and payment policy changes for certain recurring supplies

Effective March 1, 2015, Blue Cross Blue Shield of Michigan will align with the Centers for Medicare & Medicaid Services Billing Frequency Policy to allow suppliers to dispense more than a one-month supply at a time for recurring continuous positive airway pressure, nebulizer, urological and ostomy supplies.

Suppliers should continue to reference Benefit Explainer in web-DENIS for the usual maximum amount of supplies expected to be reasonable and necessary.

As a reminder, suppliers can’t dispense a quantity of supply that exceeds a member’s expected utilization amount. Suppliers must also be cognizant to changes or unusual utilization patterns by our members.

As a general rule, suppliers for durable medical equipment, prosthetics, orthotics and supplies must not dispense more than a three-month supply at a time. Our policy includes a five-day grace period. Suppliers should continue to reference Benefit Explainer in web-DENIS for usual maximum amount of supplies that meet Blue Cross quantity limitations.

Suppliers are required to follow the Blue Cross policy on refill requirements for DME POS medical supplies, which can be found in the June 2014 Record.

Note: This policy does not apply to MESSA members.