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May 2021
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Clarification: We’ve simplified your appeal process
Effective Oct. 1, 2020, the level 1 provider appeals process transitioned to Provider Relations & Servicing. Read more.


Inside this issue for you

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See all the articles in this issue, grouped by category, below.
Professional
We’re applying value‑based reimbursement to procedure codes for COVID‑19 vaccine, other immunizations
Prepayment Utilization Review can affect physicians’ value‑based reimbursement
RC Claim Assist available through Provider Secured Services
CareCentrix to manage authorizations for home health care for Medicare Advantage members
Pilot program with naviHealth supports Medicare Advantage members after hospital discharge
Starting in June, we’ll use clinical information to validate providers’ answers to some questionnaires in the e‑referral system
Starting June 22, additional medications will require prior authorization for Medicare Advantage members
Additional medications will require prior authorization for most members, starting May 24
Updates to preferred products for drugs covered under the medical benefit
Abecma requires prior authorization for Medicare Advantage members
Reminder: Zulresso only payable for inpatient facility claims
Updated profiling information now available for Blue Cross commercial chiropractors
Qualified providers invited to apply for designation in BDC Substance Use Treatment program
Reminder: Lunch and learn webinars for physicians and coders focus on risk adjustment, coding
New webinars and on‑demand training available
Reminder: Virtual provider symposiums to focus on patient experience, HEDIS, documentation and coding
We’re preparing for new provider training website
Starting June 1, we’ll only cover preferred hyaluronic acid products for GM, FCA and Ford commercial groups
Providers must submit musculoskeletal authorization requests to TurningPoint for URMBT non‑Medicare members
Additional medical benefit drugs to require prior authorization for some Blue Cross commercial members
Federal Employee Program offers prenatal care, well‑child resources for FEP members
All Providers
Pharmacy
Facility
RC Claim Assist available through Provider Secured Services
Save time: Don’t fax unnecessary information about inpatient stays
Starting in August, Michigan outpatient facilities must bill NDCs with NOCs or commercial claims will reject
Do’s and don’ts when submitting commercial SNF requests using the e‑referral system
Clarification: Don’t use F codes when requesting prior authorization for inpatient medical admissions
CareCentrix to manage authorizations for home health care for Medicare Advantage members
Pilot program with naviHealth supports Medicare Advantage members after hospital discharge
Starting in June, we’ll use clinical information to validate providers’ answers to some questionnaires in the e‑referral system
Starting June 22, additional medications will require prior authorization for Medicare Advantage members
Additional medications will require prior authorization for most members, starting May 24
Updates to preferred products for drugs covered under the medical benefit
Abecma requires prior authorization for Medicare Advantage members
Reminder: Zulresso only payable for inpatient facility claims
Qualified providers invited to apply for designation in BDC Substance Use Treatment program
Reminder: Lunch and learn webinars for physicians and coders focus on risk adjustment, coding
New webinars and on‑demand training available
We’re preparing for new provider training website
Starting June 1, we’ll only cover preferred hyaluronic acid products for GM, FCA and Ford commercial groups
Providers must submit musculoskeletal authorization requests to TurningPoint for URMBT non‑Medicare members
Additional medical benefit drugs to require prior authorization for some Blue Cross commercial members
For BCN news and information, see the current issue of BCN Provider News.

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