November 2015

American Well, other providers to be reimbursed for online health care
As announced in the October Record, Blue Cross Blue Shield of Michigan and Blue Care Network have contracted with American Well^®, a best-in-class telehealth company, to provide online doctor visits to our members. Read more.

Inside this issue for you

• Changes to wellness platform bring enhancements to Healthy Blue Achieve^SM, Healthy Blue Living^SM
• Providers and vendors required to take CMS fraud and compliance training
• Understanding family and individual level deductible maximums

See all the articles in this issue, grouped by category, below. For tips on navigating the electronic Record,
click here.

• American Well, other providers to be reimbursed for online health care
• Changes to wellness platform bring enhancements to Healthy Blue Achieve^SM, Healthy Blue Living^SM
• Providers and vendors required to take CMS fraud and compliance training
• Understanding family and individual level deductible maximums
• Medical Drug Utilization Management Program to include limits on some medical drugs
• BlueCard^® connection: Data Analysis supports need to verify eligibility and benefits
• Coding corner: properly documenting autism spectrum disorder
• Blue Cross to update McKesson ClaimsXten for first quarter 2016
• Reminder: determining if out-of-state lab participates with Blue Cross Blue Shield of Michigan
• Reminder: Blue Cross won’t pay for unused patient care items
• Correction: article on behavioral health upgrades in Living Healthy
• Blues highlight medical, benefit policy changes

• Year-end submission dates nearing for Diagnosis Closure Incentive Program
• New Medicare Advantage policy to block prescriptions that compromise integrity of Medicare Part D

• Benefit Explainer enhanced with more information
• We’re changing effective date for value-based reimbursement for specialists in PGIP
• Re-evaluation of applied behavior analysis autism treatment only required in certain instances
• Learn about upcoming webinars, enrollment information for licensed professional counselors
• Behavioral health vendor to provide authorization training for freestanding substance abuse facilities Dec. 3
• Blue Cross recognizes Blue Distinction Center+ designations for bariatric surgery
• Reminder: Blue Cross doesn’t cover digital breast tomosynthesis
• Utilization management program to include medical drugs administered to outpatients in hospital setting
• Reminder: flu shots, other vaccines
• Prior authorization required for Depo^®-Testosterone and its generic
• There’s still time to register for provider forums in Marquette and Sault Ste. Marie

• Utilization management program to include medical drugs administered to outpatients in hospital setting
• Prior authorization required for Depo^®-Testosterone and its generic

• Re-evaluation of applied behavior analysis autism treatment only required in certain instances
• Behavioral health vendor to provide authorization training for freestanding substance abuse facilities Dec. 3
• Blue Cross recognizes Blue Distinction Center+ designations for bariatric surgery
• Reminder: Blue Cross doesn’t cover digital breast tomosynthesis
• Reminder: Here’s what you need to know about catastrophic case audits

• Utilization management program to include medical drugs administered to outpatients in hospital setting
• Reminder: Always check prescription order date before filling
• Reminder: flu shots, other vaccines
• Prior authorization required for Depo^®-Testosterone and its generic

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