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October 2021
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What you need to know about doing business with Blue Cross
There’s certain information our participating providers need to know about doing business with Blue Cross Blue Shield of Michigan. This article provides a summary of key information. Read more.

Inside this issue for you

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

Professional

Updated edits for Medicare Plus Blue claims are coming in October 2021
Coming soon: New edits for Blue Cross commercial claims
Prior authorization requirements expanding for Medicare Advantage and BCN commercial on Jan. 1
Notice: Health care providers must attest in CAQH every 90 days
We’re expanding laboratory claims editing for Medicare Plus Blue
Multitarget genetic testing procedure code *81443 became payable Aug. 1, 2021
Clarification: ClaimsXten Modifier 59 requirements
TurningPoint updated its medical policies for musculoskeletal procedures and related services
We’re developing a provider satisfaction survey with TurningPoint
TurningPoint to review sites of care for total hip and knee surgeries for some members
Updated questionnaires in the e‑referral system
Direct reimbursement available to genetic counselors, effective Jan. 1
Here are highlights of our policy regarding sleep studies
Reminder: e‑learning lesson on E/M guidelines available on provider training website
How to submit prior authorization requests for drugs managed by AIM when the drugs are prescribed for non‑oncology diagnoses
Saphnelo and Nexviazyme require prior authorization for Medicare Advantage members
Medicare Advantage claims now using G codes for Spravato
Oncology management program to include MESSA group members, starting Jan. 1, 2022
Encourage eligible Medicare Advantage patients to get screened for colorectal cancer
Help improve health of patients with diabetes while reducing medical record review requests
Breast cancer screening rates drop in 2021
Lunch and learn webinars for physicians and coders focus on risk adjustment, coding
Reminder: New e‑learning training videos focus on Medicare Star Ratings
Reminder: On‑demand training available
Share prenatal, well‑child resources with patients

All Providers

What you need to know about doing business with Blue Cross
Contact Provider Inquiry if you have claims issues
2021 COVID‑19 HCPCS update: New code added
Benefit changes retroactive to Jan. 1, 2021, for UAW Retiree Medical Benefits Trust members
Billing chart: Blue Cross highlights medical, benefit policy changes
Next Drug Take Back Day scheduled for Oct. 23
We’d like your input on your virtual experiences during the pandemic

Pharmacy

How to submit prior authorization requests for drugs managed by AIM when the drugs are prescribed for non‑oncology diagnoses
Saphnelo and Nexviazyme require prior authorization for Medicare Advantage members
Medicare Advantage claims now using G codes for Spravato
Oncology management program to include MESSA group members, starting Jan. 1, 2022

Facility

We’re aligning local rules for acute inpatient medical admissions for Blue Cross commercial plans and requesting your input
We’re aligning local rules for acute inpatient medical admissions for BCN, Medicare Plus Blue and BCN Advantage plans
We’re requesting input from facilities by Oct. 31
Coming soon: New edits for Blue Cross commercial claims
We’re expanding laboratory claims editing for Medicare Plus Blue
Multitarget genetic testing procedure code *81443 became payable Aug. 1, 2021
TurningPoint updated its medical policies for musculoskeletal procedures and related services
We’re developing a provider satisfaction survey with TurningPoint
TurningPoint to review sites of care for total hip and knee surgeries for some members
Updated questionnaires in the e‑referral system
Here are highlights of our policy regarding sleep studies
How to submit prior authorization requests for drugs managed by AIM when the drugs are prescribed for non‑oncology diagnoses
Saphnelo and Nexviazyme require prior authorization for Medicare Advantage members
Medicare Advantage claims now using G codes for Spravato
Oncology management program to include MESSA group members, starting Jan. 1, 2022
Lunch and learn webinars for physicians and coders focus on risk adjustment, coding
Reminder: On‑demand training available

For BCN news and information, see the current issue of BCN Provider News.

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