November 2016

Blue Cross customers can opt for reference-based benefit designs
As part of our ongoing commitment to helping our customers and members better manage the cost of their health care, Blue Cross Blue Shield of Michigan is launching reference-based benefit designs. Read more.

Inside this issue for you

• Blue Cross to cover medical and pharmaceutical services for gender transition
• We’re streamlining EFT process
• Here’s our policy on ‘DAW’ or ‘dispense as written’
• 2017 early-release CPT codes issued

See all the articles in this issue, grouped by category, below. For tips on navigating the electronic Record,
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• Commercial prescription drug plans will have out-of-pocket maximum when paired with Medicare supplement products
• Certain high-cost products to treat skin conditions won’t be covered due to comparable alternatives
• Assess, compare your chiropractic clinical performance with Optum™ WebAssist
• We’ve made some changes to our allergy antigens policy
• FluMist^® not covered for 2016-17 flu season
• Michigan BAC and MPSERS members to participate in Medical Drug Prior Authorization Program
• Vitamins B6, B12 shots should only be given when medically necessary
• We’ll monitor use of 2 frequently misused E&M codes
• Coverage for procedure code *61630 ending in 2017
• Reminder: Procedure codes for transitional care management

• Blue Cross customers can opt for reference-based benefit designs
• Blue Cross to cover medical and pharmaceutical services for gender transition
• We’re streamlining EFT process
• Here’s our policy on ‘DAW’ or ‘dispense as written’
• 2017 early-release CPT codes issued
• Blue Cross to update McKesson ClaimsXten™ in January 2017
• ‘Provider consent to changers option no longer available when calling Provider Inquiry
• PARS to provide information on members’ remaining visits and days
• Coding corner reminder: Best practices for documenting diabetes
• BlueCard^® connection: Why was my claim for a Medicaid-enrolled member rejected?
• Billing chart: Blues highlight medical, benefit policy changes

• Certain high-cost products to treat skin conditions won’t be covered due to comparable alternatives
• FluMist^® not covered for 2016-17 flu season
• Michigan BAC and MPSERS members to participate in Medical Drug Prior Authorization Program

• Bill new corrected original when reporting a modifier change on outpatient psychiatric claim
• 2016 HCPCS maintenance

• Dose limits for Medicare members’ opioid prescriptions to take effect Jan. 1
• Preauthorization for Medicare Advantage PPO outpatient PT and OT coming in January

• Process for obtaining certain specialty drugs changes for URMBT non-Medicare 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 2015 American Medical Association. All rights reserved.