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December 2020
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After moving to Availity in 2021, many of our current online tools will still be available
Blue Cross Blue Shield of Michigan and Blue Care Network will move our secure provider website to the Availity^® Provider Portal in 2021. Read more.

Inside this issue for you

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

Professional

Michigan law prohibits ‘surprise billing’
New clinical editing resource helps you correct billing errors
We’re here for you — virtually
AMC Health remote monitoring program helps Medicare Advantage members who have CHF
Prior authorization requests for outpatient CAR-T therapy drugs for Medicare Advantage members
We’ll no longer cover Cosentyx for commercial members, starting Jan. 1, 2021
Skyrizi and Tegsedi covered under pharmacy benefit for Blue Cross and BCN commercial members
We won’t be re-tiering our chiropractic commercial network again this year
Update: Article on direct reimbursement to athletic trainers
Educating patients about low back pain
FEP has resources for prenatal care and well child-visits
Reminder: Inpatient admission requests submitted through e-referral may be subject to clinical review

All Providers

After moving to Availity in 2021, many of our current online tools will still be available
Reminder: Billing for COVID‑19 testing
CareCentrix to manage prior authorizations for home health care for Medicare Advantage members
CMS approves Next Generation Sequencing for certain cancer patients
State of Michigan group offers high-deductible health plan with an HSA to active employees
Meijer to move to exclusive provider organization network arrangement and offer an HPN option
Billing chart: Blues highlight medical, benefit policy changes

Facility

New clinical editing resource helps you correct billing errors
Prior authorization requests for outpatient CAR-T therapy drugs for Medicare Advantage members
Skyrizi and Tegsedi covered under pharmacy benefit for Blue Cross and BCN commercial members
Reminder: Inpatient admission requests submitted through e-referral may be subject to clinical review
New questionnaires for Blue Cross commercial, Medicare Plus Blue plans
Inpatient medical hospital peer-to-peer review request process changing for Blue Cross and BCN members
Here are requirements for submitting SNF and Flexible Benefit Option requests for FEP members
New billing requirements for reduced or no-cost devices

Pharmacy

We’ll add more vaccines to pharmacy benefit for commercial members
Prior authorization requests for outpatient CAR-T therapy drugs for Medicare Advantage members
We’ll no longer cover Cosentyx for commercial members, starting Jan. 1, 2021
Skyrizi and Tegsedi covered under pharmacy benefit for Blue Cross and BCN commercial members

DME

New billing requirements for reduced or no-cost devices

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