Enrollment open for private duty nursing agencies

As we communicated in the June 2022 Record, Blue Cross Blue Shield of Michigan is expanding its network to include private duty nursing agencies. In addition, private duty nursing services require prior authorization before providing care to the member.

On July 15, 2022, Blue Cross opened the Traditional and TRUST PPO (commercial) network to private duty nursing agencies for enrollment. As a Blue Cross provider, you’ll be paid directly for approved services, have access to member eligibility information and your contact information will be accessible to millions of our members.

To be selected for the networks, the providers must meet a list of selection standards that include:

• Have an accreditation certificate from one of the following:
• Accreditation Commission for Health Care, or ACHC
• Commission on Accreditation of Rehabilitations Facilities, or CARF
• Community Health Accreditation Program Inc., or CHAP
• The Joint Commission, or TJC
• The Substantial Compliant Medicare Site Survey
• Primary practice location in Michigan
• If applicable, verification must include the record of any disciplinary action taken or pending against the applicant.
• Absence of inappropriate utilization practices as identified through proven subscriber complaints, medical necessity audits and peer reviews.
• Absence of fraud and illegal activities.

To obtain a full list of selection standards and a copy of the proposed agreement, email PDN@bcbsm.com. This email address will only be valid through Sept. 30, 2022.

Training
Our dedicated provider training site gives you easy access to recorded webinars, videos, eLearning modules and other training resources. Click here for instructions to register and log in. We recommend using the same email you use to communicate with Blue Cross for provider-related needs. This will become your user ID.

Prior authorization
As a reminder, private duty nursing services will require prior authorization, effective for dates of service beginning Oct. 1, 2022. We’ll begin accepting requests for prior authorization starting Sept. 1, 2022. Prior authorizations will be submitted through e-referral.

For billing and authorization requests, agencies should use S9123 for RN or S9124 for LPN and indicate total hours as units (1 unit = 1 hour).