December 2019

We're adding two medical drugs to the site-of-care program for Blue Cross and Blue Care Network commercial members starting April 1, 2020

Updated — Medicare Part B medical specialty drug authorization: Clarification regarding Prolia and Xgeva

Additional medical benefit specialty drugs will have authorization and site of care requirements for Blue Cross’ PPO and BCN HMO^SM members in January and February 2020

e-referral system out of service for maintenance Dec. 21-22

Medicare Part B medical specialty drug prior authorization list is changing in March

We've resolved issues with processing SNF claims for Medicare Advantage members

e-referral system unavailable from 8 to 10 a.m. Saturday, Dec. 7

How to submit inpatient authorization requests to BCN during upcoming holiday closures

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closures

How to handle authorization requests for physical, occupational and speech therapy continuing into 2020

Reminder: Michigan board-certified behavior analysts must be licensed starting Jan. 7, 2020, to be reimbursed by BCN and Blue Cross

November 2019

We're adding two medical drugs to the PPO commercial site of care requirements starting in January

Provider appeal time frame extended for Blue Cross' PPO admissions

Additional medical benefit specialty drugs will require prior authorization for Blue Cross' PPO and BCN HMO^SM members

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closures

How to submit inpatient authorization requests to BCN during upcoming holiday closures

Register for a webinar about hyaluronic acid products for knee injections

e-referral system out of service for maintenance Nov. 16-17

We're aligning peer-to-peer review request processes for acute non-behavioral health non-elective inpatient admissions

Tell us what you think about our utilization management services

October 2019

Medicare Part B medical specialty drug prior authorization list is changing in February

For Blue Cross' PPO (commercial) and BCN HMO^SM (commercial) members, ketoprofen 25 mg will require authorization and have new quantity limits

BCN to deny claims for unauthorized outpatient toxicology laboratory services by non-JVHL laboratories starting Jan. 1, 2020

Starting Nov. 1, changes in authorizing human organ transplants for BCN members

e-referral system out of service for maintenance Oct. 19-20

The oncology management program will include Medicare Advantage plans starting Jan. 1, 2020

September 2019

Starting Jan. 1, 2020, we'll cover select hyaluronic acid products

For Medicare Plus Blue^SM PPO, the Specialty Medication Prior Authorization Program is expanding to include all sites of care except inpatient

Effective immediately, plan notification is no longer required for endometrial ablation and excisional breast biopsy procedures for BCN members

Effective Jan. 1, 2020, Eylea^® and Lucentis^® will require authorization for Blue Cross' PPO (commercial) members

Starting Jan. 1, 2020, Blue Cross' PPO and BCN HMO^SM plans will cover hemophilia drugs under members' pharmacy benefits

Updated e-referral questionnaires to open Sept. 29 for BCN and Medicare Plus Blue^SM PPO

Reminder: Starting Oct. 1, 2019, naviHealth will authorize PDPM levels for Medicare Advantage SNF admissions

e-referral system out of service for maintenance Sept. 21-22

How can we improve our online tools?

New webinars available in September and October for BCN

New webinars available in September and October for Blue Cross

August 2019

Providers invited to Medicare Stars events in Michigan

Endometrial ablation and excisional breast biopsy procedures for BCN members require plan notification, not authorization

Skilled nursing facilities must follow CMS guidelines for issuing NOMNC forms to Medicare Advantage members

naviHealth webinars about SNF PDPM payment methodology

Evenity^® will be added to the Medicare Part B medical drug prior authorization list in November

Update: Board-certified behavior analysts must have current Michigan license by Jan. 7, 2020, to be reimbursed by Blue Cross and BCN

How to submit inpatient authorization requests to BCN during upcoming holiday closure

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closure

New and updated e-referral questionnaires to open August 25 for BCN and Medicare Plus Blue^SM PPO

How can we improve our online tools?

Medical record documentation requirements for ABA services are updated

Changes to BCN member transfer request form

Submit BCN enteral nutrition authorization requests using the e-referral system

Clarification: Preferred infliximab strategy for adult Blue Cross' PPO (commercial) members

TAVI/TAVR procedures for BCN members require plan notification, not authorization

Don’t add clinical documentation to denied requests in the e-referral system

Requirements for assessments of Medicare Advantage members in skilled nursing facilities

You may experience e-referral system performance issues August 3 and August 4

July 2019

Reminder: Effective August 1, authorizations must be obtained from AIM Specialty Health^® for most medical oncology and supportive care medications for BCN HMO^SM (commercial) members

We're making changes to the Medicare Advantage SNF post-payment audit and recovery process

Medicare Part B medical specialty drug prior authorization list is changing in October

Effective November 1, Inflectra^® is the preferred infliximab product for adult Blue Cross' PPO (commercial) members

Correct fax number for submitting post-acute care discharge information to naviHealth

Reminder: Medicare Part B medical specialty drug prior authorization list changing July 22, 2019

Providers and office staff: register now for our upcoming training webinars

We're adding drugs to prior authorization, site of care programs for PPO members, effective October 2019

Comprehensive lists of requirements available for medical specialty drugs and pharmacy benefit drugs

Additional medical benefit specialty drugs have authorization and site of care requirements for BCN HMO^SM members, effective Oct. 1, 2019

June 2019

We'll continue to update clinical edits to comply with current coding guidelines

NovoLogix^® user interface enhancements coming soon

Enter BCN retrospective authorization requests for cardiology and radiology services in e-referral

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closure

How to submit inpatient authorization requests to BCN during upcoming holiday closure

Important information about eviCore healthcare therapy authorization requests for BCN

Expanding BCN medical coverage for transgender employees of the University of Michigan

Register now for an AIM Specialty Health^® oncology management program webinar

Contact eviCore healthcare's Client & Provider Services for help in using the new eviCore provider portal for BCN PT, OT and ST authorizations

More updated e-referral questionnaires open on June 23

Reminder: naviHealth manages authorization requests only for Medicare Advantage post-acute care

No authorization required for BCN initial PT, OT and ST evaluations

Additional medical benefit specialty drugs require prior authorization for Blue Cross' PPO and BCN HMO^SM members

May 2019

Reminder: Medicare Advantage post-acute care authorization changes begin June 1

How to use Allscripts or CarePort Care Management for Medicare Advantage post-acute care requests

We're using updated utilization management criteria for behavioral health starting Aug. 1, 2019

Starting June 1, BCN and Blue Cross are accepting applied behavior analysis claims with 2019 procedure codes

Reminder: Submit BCN initial and follow-up authorization requests for PT, OT and ST to eviCore starting May 27, 2019

Updated authorization criteria and e-referral questionnaire for ethmoidectomy

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closure

How to submit inpatient authorization requests to BCN during upcoming holiday closures

Medicare Part B medical specialty drug prior authorization list changing July 22, 2019

More BCN questionnaires to open on June 23 in e-referral

Learn about Medicare Advantage post-acute care authorization changes

Effective June 1, Spravato^™ will be added the prior authorization program for Blue Cross and BCN commercial members.

April 2019

Effective July 1, transgender benefits expand for University of Michigan members

How to submit inpatient authorization requests to BCN during upcoming holiday closure

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closure

Call BCN for cardiology and radiology authorization requests with dates of service prior to Oct. 1, 2018

BCN Advantage^SM to audit SNF claims for RUG codes starting June 1

March 2019

Effective July 1, Khapzory^TM and Fusilev^® will be added the prior authorization program for PPO commercial members

Medicare Part B medical specialty drug prior authorization lists changing in June 2019

Submit BCN initial and follow-up authorization requests for PT, OT and ST to eviCore starting May 27, 2019

Behavioral health components of AAEC evaluation do not require authorization for BCN members

What to do when error messages display in e-referral

Use form to request criteria for BCN authorization decisions (non-behavioral health)

Additional changes to BCN process for requesting peer-to-peer review of non-behavioral health cases

February 2019

Home page change coming to e-referral, starting Feb. 25

Start transitioning adult BCN HMO members using infliximab products to Inflectra^®

New vendor managing Medicare Advantage patient transfers to post-acute care facilities, starting June 1

Prior-authorization changes for Blue Cross URMBT non-Medicare members

Clarifying biofeedback and neurofeedback authorization requirements for BCN members

BCN otoplasty and rhinoplasty questionnaires to open on Feb. 10 in e-referral

Medicare Plus Blue^SM facility claims for Prolastin^® and Aralast^TM no longer deny for lack of documentation

January 2019

Sign up to receive Blues Brief electronically

Complete the new questionnaires in e-referral for BCN members

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closure

How to submit inpatient authorization requests to BCN during upcoming holiday closure