The Record

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All Providers

October 2017
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Blue Cross to implement 2017 InterQual^® criteria Oct. 2
Blue Cross Blue Shield of Michigan will implement InterQual^® acute care, rehabilitation, long-term acute care, skilled nursing and home health criteria on Oct. 2, 2017. On this date, newly modified InterQual criteria will take effect and all previously published modifications (local rules) will be replaced with the new criteria. Read more.

Inside this issue for you

See all the articles in this issue, grouped by category, below.

All Providers

Blue Cross to implement 2017 InterQual^® criteria Oct. 2
Preauthorization program for commercial Blue Cross PPO plans coming in January
Pharmacy network change for Blue Cross and BCN Medicare Part D plans
10 tips to improve your BlueCard^® experience
Blue Cross won’t cover services rendered and prescriptions issued by sanctioned providers
Coding corner: Seizures vs. epilepsy
Reminder: Blue Cross doesn’t reimburse claims for experimental, investigational or medically unnecessary services
CPT Category II and Z codes aid data collection and lessen administrative work for offices
HCPCS update: New modifier added
Billing chart: Blues highlight medical, benefit policy changes

Pharmacy

Medication therapy management: A tool to help patients reach their treatment goals
We no longer require patient signatures for home drug deliveries

Professional

Medicare Plus Blue^SM PPO updating claim editing processes
Blue Cross updates policy for medical specialty drug infusions
Verscend Technologies to retrieve medical records for Blue Cross, BCN commercial risk adjustment services
Reminder: Update your Provider Authorization form when changes occur
Here are some FEP checklists for criteria that’s required for review of medical necessity
Medication therapy management: A tool to help patients reach their treatment goals
Patient signatures no longer required for home infusion therapy deliveries
Ensure accurate medical records for patients with high blood pressure
New digital tools help members navigate their plans
Reminder: Re-enrollment with Blue Cross and BCN for physician assistants starts October 2017

Facility

Here’s what you need to know about Blue Cross inpatient authorization requirements
We’re changing how behavioral health facilities handle certain requests for Medicare Plus Blue^SM members
Medicare Plus Blue^SM PPO updating claim editing processes
Blue Cross updates policy for medical specialty drug infusions
Verscend Technologies to retrieve medical records for Blue Cross, BCN commercial risk adjustment services
Reminder: Update your Provider Authorization form when changes occur
Here are some FEP checklists for criteria that’s required for review of medical necessity
Precertification, signed consent for case management must be obtained before residential treatment center admission for FEP members

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