Change to medication reconciliation reimbursement for Medicare Plus Blue claims

Currently, Blue Cross Blue Shield of Michigan and Blue Care Network reimburse providers $35 for a Medicare Plus Blue℠ or a BCN Advantage℠ member when medication reconciliation is conducted after a hospital discharge and a claim is submitted for procedure code *1111F.

For claims submitted on or after Jan. 1, 2024, the charge on claims for code *1111F must be at least $35 to receive the full payment of $35. Blue Cross will no longer reimburse amounts greater than the amount charged on the claim. This is a change for Medicare Plus Blue claims.

To qualify for reimbursement, follow these steps:

1. When the Medicare Plus Blue or BCN Advantage member is discharged after a hospital stay, perform medication reconciliation by comparing the hospital discharge medications against the member’s current list of medications.
2. Submit code *1111F on the claim form with a charge of at least $35 within 30 days of the member’s discharge.