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July 2023
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Help patients avoid being balance billed by noncontracted ambulance services
Health care providers should order transfers only from contracted ambulance services when arranging for non-emergency ground transfers to prevent patients from being balance billed large amounts from noncontracted ambulance services. Read more.


Inside this issue for you

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See all the articles in this issue, grouped by category, below.
Professional
Blue Cross begins using Quartet to help connect members with behavioral health providers
We’ll use 2023 InterQual criteria, starting Aug. 1
Behavioral health providers: How to bill prolonged services
Starting in August, Blue Cross to provide behavioral health benefits for GM hourly employees with group number 83200
Reminder: Blue Cross now covers in-state mental health services provided by intensive outpatient programs
Reminder: Blue Cross now covers partial hospitalization program services for substance use disorders
Starting Aug. 15, we’ll require prior authorization for some diabetes drugs
Elahere, Imjudo, Tecvayli and Lunsumio to require prior authorization for most members, starting Aug. 23
Clarification: Xgeva continues to require prior authorization through NovoLogix for most commercial members
Carelon to expand existing prior authorization program, starting Sept. 1
We’ve made questionnaire changes in e-referral system
Forest Hills Pediatric Associates: Using PCMH and Collaborative Care to better serve patients
Reminders: Our affiliation agreements and our concierge medicine policy
Well-managed chronic conditions can help members avoid ER visits or hospital stays
Lunch and learn webinars for physicians and coders focus on risk adjustment, coding
New training guide for behavioral health providers posted on training site
Reminder: Physical medicine treatment plans developed by chiropractors
We’ve updated and posted our 2023 HEDIS tip sheets
We’ve updated medical record documentation guidelines for musculoskeletal procedures
We’ve made updates to list of musculoskeletal procedure codes that require prior authorization
All Providers
Facility
For BCN news and information, see the current issue of BCN Provider News.

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