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July 2022
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Program provides mobile crisis assessment and stabilization for mental health and substance use
As you may have read last September in The Record, Blue Cross Blue Shield of Michigan began offering a new method of obtaining crisis assessment and stabilization services for mental health and substance use, effective Oct. 1, 2021. This article provides additional details. Read more.

Inside this issue for you

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

Professional

Blue Cross and BCN add new virtual option for behavioral health care
Clinical quality corner: Coordination of care
Landmark Health high-intensity in-home care program expands Oct. 1
We’re removing age limits for autism spectrum disorder services
Reminder: Members can’t receive prescriptions for DME/P&O items through telehealth visits
All behavioral health practitioner specialty changes require new enrollment
2022 InterQual criteria to be implemented Aug. 1
Coding Advisor outreach to educate providers about appropriate use of procedure codes
Update: Reminder of appropriate use of modifier 59 and related X modifiers for Medicare Plus Blue claims
Follow these billing guidelines for removal of impacted cerumen
Leqvio to have site-of-care requirement for commercial members, starting Aug. 1
Fyarro to require prior authorization for most members, starting Aug. 16
Fyarro and Tivdak will have requirements for URMBT members with Blue Cross non-Medicare plans
Fusilev no longer requires prior authorization
What you need to know about submitting medical benefit drug prior authorization requests for Medicare Advantage members
Cortrophin and Ryplazim to have requirements for URMBT members with Blue Cross non-Medicare plans
AllianceRx Walgreens Prime is now AllianceRx Walgreens Pharmacy
Blue Cross introducing payment policy for multiple therapy services
Reminder: 2% Medicare sequestration reduction slated to resume July 1
New on-demand training available
Lunch and learn webinars focus on risk adjustment, coding
Do we have your medical records request address?
Learn what you can do to better manage osteoporosis and limit disability
Remember to discuss fall risk, urinary incontinence and physical activity with Medicare patients
Prenatal, well-child support for FEP members with growing families
Additional procedures codes payable to OPC providers for Blue Cross commercial members, starting July 1

All Providers

Program provides mobile crisis assessment and stabilization for mental health and substance use
Blue Cross recognized as No. 1 in customer satisfaction among commercial health plans in Michigan
Provider Secured Services, including web-DENIS, end date extended for some functions
Here are resources for learning about our new provider portal
Clarification: At-home COVID-19 testing policy revised for Blue Cross, BCN commercial plans
Amendments made to Trading Partner Agreement
Chippewa County War Memorial Hospital changed its name
Billing chart: Blue Cross highlights medical, benefit policy changes

Pharmacy

Leqvio to have site-of-care requirement for commercial members, starting Aug. 1
Fyarro to require prior authorization for most members, starting Aug. 16
Fyarro and Tivdak will have requirements for URMBT members with Blue Cross non-Medicare plans
Fusilev no longer requires prior authorization
What you need to know about submitting medical benefit drug prior authorization requests for Medicare Advantage members
Cortrophin and Ryplazim to have requirements for URMBT members with Blue Cross non-Medicare plans
AllianceRx Walgreens Prime is now AllianceRx Walgreens Pharmacy

DME

Reminder: Members can’t receive prescriptions for DME/P&O items through telehealth visits

Facility

2022 InterQual criteria to be implemented Aug. 1
Coding Advisor outreach to educate providers about appropriate use of procedure codes
Here’s what you need to know about Prepayment Laboratory Claim Edits and how to provide input
What facilities need to know about proposed new policy for multiple therapy services and how to provide input
Update: DRG Clinical Validation Audit implementation
Update: Emergency Department Claims Analyzer implementation
We’ve updated Addendum C of Blue Cross’ Ambulatory Surgical Facility Traditional Participation Agreement
Leqvio to have site-of-care requirement for commercial members, starting Aug. 1
Fyarro to require prior authorization for most members, starting Aug. 16
Fyarro and Tivdak will have requirements for URMBT members with Blue Cross non-Medicare plans
Fusilev no longer requires prior authorization
What you need to know about submitting medical benefit drug prior authorization requests for Medicare Advantage members
Cortrophin and Ryplazim to have requirements for URMBT members with Blue Cross non-Medicare plans
We’re sharing skilled nursing facilities’ performance reporting for Medicare Advantage members
Lunch and learn webinars focus on risk adjustment, coding
Do we have your medical records request address?
Additional procedures codes payable to OPC providers for Blue Cross commercial members, starting July 1

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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