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November 2022
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November is Lung Cancer Awareness Month
Lung cancer is the leading cause of cancer death worldwide, according to the Lung Cancer Research Association. An estimated 236,740 people will be diagnosed with lung cancer in the U.S. this year. Read more.

Inside this issue for you

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

Professional

Community health care workers can address social needs and improve health outcomes
Requirements changed for some commercial medical benefit drugs
Cimerli now requires prior authorization for Medicare Advantage members
Prior authorization required for Spevigo for Medicare Advantage members
Starting Jan. 1, we’ll change how we cover some prescription drugs
We’re changing how we manage biologic asthma therapies, starting Jan. 1
For some providers, process for updating your information with us changing in November
New and updated questionnaires in e-referral system
Benefit changes coming in 2023 for UAW Retiree Medical Benefits Trust members
Management of medical benefit drugs moving from Accredo to Blue Cross for URMBT Blue Cross non-Medicare members
Additional medical benefit drugs will require prior authorization for URMBT members with Blue Cross non-Medicare plans starting Jan. 1
Coding update coming next year for Medicare Plus Blue pathology claims
New HEDIS measure: Follow-up after emergency department visit is key to good patient care
Transitions of Care HEDIS measure focuses on medication management and care coordination
HEDIS measure focuses on helping prevent unnecessary hospital readmissions
We’ve updated and posted our 2022 HEDIS tip sheets
Clarification: DME/P&O and telehealth visits
Closing HEDIS gaps for medication compliance
Avsola to require prior authorization for Blue Cross and Blue Shield Federal Employee Program non-Medicare members starting Jan. 1
Follow these guidelines for billing genetic testing
Lunch and learn webinars focus on risk adjustment, coding

All Providers

November is Lung Cancer Awareness Month
Have questions about our policies? Check out these online resources
Submit application to join Blue High Performance Network
Final Provider Secured Services and web-DENIS retirement dates announced along with Availity enhancements
Estimate Your Cost tool to launch Jan. 1
Reminder: Access the Blue Cross Commercial Provider Manual on our new provider portal
Reminder: Use U09.9 for long-term COVID-19 as a secondary diagnosis code
Billing chart: Blue Cross highlights medical, benefit policy changes

Pharmacy

Requirements changed for some commercial medical benefit drugs
Cimerli now requires prior authorization for Medicare Advantage members
Prior authorization required for Spevigo for Medicare Advantage members
Starting Jan. 1, we’ll change how we cover some prescription drugs
We’re changing how we manage biologic asthma therapies, starting Jan. 1
Management of medical benefit drugs moving from Accredo to Blue Cross for URMBT Blue Cross non-Medicare members
Additional medical benefit drugs will require prior authorization for URMBT members with Blue Cross non-Medicare plans starting Jan. 1
Avsola to require prior authorization for Blue Cross and Blue Shield Federal Employee Program non-Medicare members starting Jan. 1

Facility

Medicare Plus Blue and BCN Advantage claims audits transitioning from HMS to Cotiviti
Requirements changed for some commercial medical benefit drugs
Cimerli now requires prior authorization for Medicare Advantage members
Prior authorization required for Spevigo for Medicare Advantage members
Starting Jan. 1, we’ll change how we cover some prescription drugs
We’re changing how we manage biologic asthma therapies, starting Jan. 1
For some providers, process for updating your information with us changing in November
Benefit changes coming in 2023 for UAW Retiree Medical Benefits Trust members
Management of medical benefit drugs moving from Accredo to Blue Cross for URMBT Blue Cross non-Medicare members
Additional medical benefit drugs will require prior authorization for URMBT members with Blue Cross non-Medicare plans starting Jan. 1
Coding update coming next year for Medicare Plus Blue pathology claims
Avsola to require prior authorization for Blue Cross and Blue Shield Federal Employee Program non-Medicare members starting Jan. 1
Follow these guidelines for billing genetic testing
Lunch and learn webinars focus on risk adjustment, coding

DME

Clarification: DME/P&O and telehealth visits

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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