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August 2022
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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. Read more.

Inside this issue for you

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

Professional

CS modifier limited to specific codes that result in COVID-19 testing for commercial plans, effective Sept. 1
Reminder: Use modifier 59 and related X modifiers for Medicare Plus Blue claims appropriately
Submit clinical documentation in timely manner for faster Medicare Advantage DME authorizations
Requirements changed for some commercial medical benefit drugs
Oxlumo to have site-of-care requirement for commercial members beginning in October
Blue Cross, BCN covering additional vaccine
We’re updating our HEDIS and Star tip sheets for 2022
Lunch and learn webinars focus on risk adjustment, coding
New on-demand training available
Here are resources to promote flu vaccination and educate patients about avoiding antibiotic use for acute bronchitis
Keep your Provider Authorization form updated
Reminder: Concierge practices must comply with their Blue Cross affiliation agreements
Blue Cross professional providers may get new messages regarding medical drug claims for commercial members

All Providers

Enrollment open for private duty nursing agencies
New emergency line for behavioral health goes live
New collections vendor for FEP claims
HCPCS replacement codes, effective July 1, 2022, established
HCPCS 2nd-quarter update: New and updated codes
Billing chart: Blue Cross highlights medical, benefit policy changes

Pharmacy

Requirements changed for some commercial medical benefit drugs
Here are updated guidelines for billing self-administered medications provided in outpatient facilities
Oxlumo to have site-of-care requirement for commercial members beginning in October
Blue Cross, BCN covering additional vaccine

DME

Submit clinical documentation in timely manner for faster Medicare Advantage DME authorizations

Facility

Post-acute care providers need direct access to naviHealth’s provider portal
DRG clinical validation audits will begin in September for Medicare Plus Blue claims
CS modifier limited to specific codes that result in COVID-19 testing for commercial plans, effective Sept. 1
Improved process for prior authorization requests for initial SNF stays for Medicare Advantage members
Requirements changed for some commercial medical benefit drugs
Here are updated guidelines for billing self-administered medications provided in outpatient facilities
Oxlumo to have site-of-care requirement for commercial members beginning in October
Lunch and learn webinars focus on risk adjustment, coding
Keep your Provider Authorization form updated

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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