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May 2025
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Dr. Beecroft: Presenting a synopsis of the current thinking around autism etiology and treatment
The science behind an autism diagnosis and its treatment is changing very rapidly, which is a good thing for our members, according to Dr. William Beecroft, medical director of behavioral health at Blue Cross Blue Shield of Michigan. Read more.

Inside this issue for you

Provider portal pointers: Submitting an eligibility and benefits request
Billing chart: Blue Cross highlights medical, benefit policy changes
Behavioral health providers shouldn’t submit claims for behavioral health collaborative care services

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

Professional

We invite you to join PGIP as a physician organization
Webinars for physicians, coders focus on documentation, coding
On-demand opportunities are available for provider training
Register now for 2025 virtual provider symposium sessions
Check out resources for heart health, antibiotic use, immunizations
Reminder: Prior authorization won’t be required for pain management procedures for Medicare Advantage members, starting May 1
Tyenne will be preferred tocilizumab biosimilar product for most commercial members, starting June 1
We won’t be implementing STI clinical test code bundle for Blue Cross commercial
Complete Continuity of Care Guideline in e referral system for some Medicare Advantage members
Update: Commercial prior authorization requests submitted through NovoLogix must be submitted through a different application
We’ve made changes to prior authorization for select services
Pharmacy news roundup
Reminder: Chiropractors invited to join new quality reward program

All Providers

Dr. Beecroft: Presenting a synopsis of the current thinking around autism etiology and treatment
Provider portal pointers: Submitting an eligibility and benefits request
Billing chart: Blue Cross highlights medical, benefit policy changes
Behavioral health providers shouldn’t submit claims for behavioral health collaborative care services
HCPCS replacement codes established, effective April 1, 2025
2025 HCPCS 1st-quarter update: New, deleted codes
Reminder: How to check the status of prior authorization requests to share with your patients
Do you have time for a Quality Minute about patient care?
Here’s an overview of Identification of Microorganisms Using Nucleic Acid Probes policy

Facility

Professional reimbursement increased for select procedures performed in ambulatory surgical facilities
Skilled nursing facility claim reviews resume for Medicare Plus Blue on June 1, 2025.
Reminder: Prior authorization won’t be required for pain management procedures for Medicare Advantage members, starting May 1
Tyenne will be preferred tocilizumab biosimilar product for most commercial members, starting June 1
We won’t be implementing STI clinical test code bundle for Blue Cross commercial
Complete Continuity of Care Guideline in e referral system for some Medicare Advantage members
Update: Commercial prior authorization requests submitted through NovoLogix must be submitted through a different application
We’ve made changes to prior authorization for select services
Pharmacy news roundup

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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