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April 2022
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Availity transition dates announced
In March, you should have received a Welcome to Availity special edition provider newsletter. Please take the time to read through it, and share it with others in your office who need Blue Cross and BCN online information. Read more.

Inside this issue for you

Blue Cross advances efforts to transform care delivery, including support for physicians
Newly redesigned Blue Cross Commercial Provider Manual coming later this month
Update: Blue Distinction Centers for Substance Use Treatment and Recovery

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

Professional

Blue Cross changing practitioner fees July 1
Update: EMS providers can be reimbursed for administering monoclonal antibody COVID‑19 infusions in any location
Reminder: Don’t resubmit claims involved in audits
Overweight and obesity diagnoses now payable diagnosis codes
Save time when submitting prior authorization requests for prescription drugs
Do we have your medical records request address?
Outpatient PT, OT services no longer require prior authorization for Medicare Plus Blue members
Reminder: RC Claim Assist available through Provider Secured Services
Clarification: Billing for IOP services provided via telemedicine for some members
Requirements changed for some commercial medical benefit drugs
Enjaymo, Vabysmo and Byooviz to require prior authorization for Medicare Advantage members
Nyvepria, Rybrevant to require prior authorization for URMBT members with Blue Cross non-Medicare plans
We’ve updated payment policy for Unna boot or multilayer compression dressing
TurningPoint authorizations for musculoskeletal surgical and related procedures are valid for 6 months
Musculoskeletal procedure authorizations: Reminders for facilities
Pilot program with TurningPoint supports your patients’ musculoskeletal care
Next phase of nonclinical, transitional care program to begin May 1
Some Meijer employees or their spouses aren’t required to pay primary care and specialist office visit copays or coinsurance
New HEDIS Star measure highlights importance of follow-up care after emergency department visits
Transitions of Care HEDIS Star measure focuses on medication management, care coordination for Medicare Advantage patients
American Heart Association offers resources to help your patients manage their health conditions
Virtual provider symposium: Register now for 2022 sessions
Lunch and learn webinars focus on risk adjustment, coding

All Providers

Availity transition dates announced
Blue Cross advances efforts to transform care delivery, including support for physicians
Newly redesigned Blue Cross Commercial Provider Manual coming later this month
Update: Blue Distinction Centers for Substance Use Treatment and Recovery
Next Drug Take Back Day scheduled for April 30
No need to submit new authorization requests for Neulasta for HCPCS code J2506
Billing chart: Blue Cross highlights medical, benefit policy changes

Pharmacy

Outpatient facilities must bill self-administered medications through Medicare Part D
Requirements changed for some commercial medical benefit drugs
Enjaymo, Vabysmo and Byooviz to require prior authorization for Medicare Advantage members
Nyvepria, Rybrevant to require prior authorization for URMBT members with Blue Cross non-Medicare plans
Next phase of nonclinical, transitional care program to begin May 1

DME

Orthotic Devices Policy updated to cover K1015, effective Nov. 1, 2021

Facility

Temporary suspension of clinical review requirements for skilled nursing facility admissions has ended
Outpatient facilities must bill self-administered medications through Medicare Part D
Reminder: Don’t resubmit claims involved in audits
Overweight and obesity diagnoses now payable diagnosis codes
Do we have your medical records request address?
Outpatient PT, OT services no longer require prior authorization for Medicare Plus Blue members
Clarification: Billing for IOP services provided via telemedicine for some members
Requirements changed for some commercial medical benefit drugs
Enjaymo, Vabysmo and Byooviz to require prior authorization for Medicare Advantage members
Nyvepria, Rybrevant to require prior authorization for URMBT members with Blue Cross non-Medicare plans
We’ve updated payment policy for Unna boot or multilayer compression dressing
TurningPoint authorizations for musculoskeletal surgical and related procedures are valid for 6 months
Musculoskeletal procedure authorizations: Reminders for facilities
Lunch and learn webinars focus on risk adjustment, coding

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

For news and information about our strategic goals and initiatives, see the current issue of Hospital and Physician Update.

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