December 2016

Our first group customer selects Reference Based Benefits feature for certain member segments
Last month, we told you about a new benefit feature that some of our large, national customers are looking at — Reference Based Benefits, or RBB. This new feature encourages members to use online tools to help compare the costs of certain services and also establishes a reference price for those services. Read more.

Inside this issue for you

• Basic organ, bone marrow transplant donor services covered in 2017
• Check bcbsm.com for recent prescription drug lists
• Streamlined EFT process starts in December
• In February 2017, we’re discontinuing VBR for J-code oncology subset

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

• Our first group customer selects Reference Based Benefits feature for certain member segments
• Basic organ, bone marrow transplant donor services covered in 2017
• Check bcbsm.com for recent prescription drug lists
• Streamlined EFT process starts in December
• In February 2017, we’re discontinuing VBR for J-code oncology subset
• Online visits and telemedicine claims reporting clarified
• PARS to provide members’ remaining visits or days in December 2016
• Skilled Nursing Facility Pay-for-Performance program offers opportunities to earn incentive rewards
• HCPCS codes added, deleted; a code effective date changed
• Correction: Use J9310 for rituximab to treat patients with Devic disease
• Billing chart: Blues highlight medical, benefit policy changes

• Participants in urological surgery collaborative get additional reimbursement opportunity
• Requirements for 2 Blue Cross wellness products change
• Here’s what you need to know about the plan all-cause readmissions measure
• Select multiple diagnostic imaging procedures performed on same day pay more in 2017
• Bill all ambulance services by pickup ZIP code

• Bill all ambulance services by pickup ZIP code
• We’re changing our reimbursement policy for hospice services
• Follow these guidelines for an audit of catastrophic case outlier

• Reminder: Submit 2016 service dates for Medicare Advantage Diagnosis Closure Incentive program
• Reminder: Dose limits for Medicare members’ opioid prescriptions to take effect Jan. 1

• Reminder: Coverage criteria for TENS unit

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.