Archives 2022




December 2022

Assisted reproductive technology benefit expanded, starting Jan. 1. 2023 (PDF)

Generic pemetrexed to require prior authorization for Medicare Advantage members, starting Jan. 1 (PDF)

BCN to use updated InterQual® ABA criteria starting March 1 (PDF)

Cognitive rehabilitation questionnaire to be removed from e-referral system on Dec. 18 (PDF)

Questionnaires to be removed from e-referral system on Dec. 18 (PDF)

RebyotaTM to require prior authorization for most commercial members starting Jan. 5 (PDF)

December-January holiday closures: How to submit inpatient authorization requests (PDF)

Fylnetra® and RolvedonTM to require prior authorization for most commercial members starting March 13 (PDF)

e-referral system out of service for maintenance overnight Dec. 17-18 (PDF)

AIM won’t require prior authorization for 29 medical oncology drugs for most members starting Jan. 1 (PDF)

Updated fax forms for submitting prior authorization requests to TurningPoint for musculoskeletal procedures (PDF)

Hemgenix® and TzieldTM to require prior authorization for most members starting in December (PDF)

Issue now resolved: eviCore healthcare® call center phone and fax lines are currently unavailable (PDF)

November 2022

XenpozymeTM and Spevigo® to have site-of-care requirements for most commercial members starting March 1 (PDF)

New and updated questionnaires in the e-referral system starting Nov. 27 (PDF)

Outpatient ECT won’t require prior authorization for BCN members, starting Jan. 1 (PDF)

Nov. 24-25 holiday closure: How to submit inpatient authorization requests (PDF)

Updated Gastric stimulation questionnaire in the e-referral system (PDF)

Fylnetra® to require prior authorization for Medicare Advantage members, starting Dec. 19 (PDF)

e-referral system out of service for maintenance overnight Nov. 19-20 (PDF)

Pemfexy® to require prior authorization for most members starting Feb. 9 (PDF)

Availity® Essentials services have been fully restored (PDF)

How to speed up the review process for AIM prior authorization requests (PDF)

October 2022

Nov. 8 holiday closure: How to submit inpatient authorization requests (PDF)

Prior authorization and billing reminders for SNF interrupted stays for Medicare Advantage members (PDF)

Updates related to swallow services for BCN (PDF)

CareCentrix® home health care: Reference materials and recorded training will be available Oct. 27, 2022 (PDF)

Reimbursement for certified opioid treatment programs to change in 2023 (PDF)

XenpozymeTM and Zynteglo® to require prior authorization for Medicare Advantage members, starting Nov. 1 (PDF)

e-referral system out of service for maintenance overnight Oct. 15-16 (PDF)

Skysona® to require prior authorization for most commercial members starting Oct. 20 (PDF)

CareCentrix® home health care: Improved processes for prior authorization requests for Medicare Plus Blue (PDF)

Avsola® to require prior authorization for Blue Cross and Blue Shield Federal Employee Program® non-Medicare members starting Jan. 1 (PDF)

September 2022

AIM ProviderPortal operating slowly (PDF)

Update: We’re changing how we manage biologic asthma therapies, starting Jan. 1 (PDF)

Additional medical benefit drugs will require prior authorization for URMBT members with Blue Cross non-Medicare plans starting Jan. 1 (PDF)

Management of medical benefit drugs moving from Accredo® to Blue Cross for URMBT Blue Cross non-Medicare members (PDF)

Issue now resolved: AIM ProviderPortal operating slowly (PDF)

e-referral training tools updated (PDF)

Spevigo® to require prior authorization for most commercial members starting Oct. 13 (PDF)

SNF outpatient therapies: How to submit prior authorization requests for BCN members (PDF)

Xenpozyme™ to require prior authorization for most commercial members, starting Oct. 6 (PDF)

Spevigo® to require prior authorization for Medicare Advantage members, starting Sept. 26 (PDF)

e-referral system out of service for maintenance overnight Sept. 17-18 (PDF)

CimerliTM to require prior authorization for Medicare Advantage members starting Oct. 3 (PDF)

Update: Updated questionnaires in the e-referral system starting Sept. 11 (PDF)

Zynteglo® to require prior authorization for most commercial members starting Sept. 22 (PDF)

More Medicare Advantage members to become eligible for Landmark Health’s in-home care program (PDF)

OpdualagTM to require prior authorization for most members starting Dec. 1 (PDF)

August 2022

Skyrizi® IV to have site-of-care requirement for most commercial members starting Dec. 1 (PDF)

September 5 holiday closure: How to submit inpatient authorization requests (PDF)

New and updated questionnaires in the e-referral system starting Aug. 28 (PDF)

CimerliTM to require prior authorization for most commercial members starting Sept. 1 (PDF)

Availity® administrators: Set up Health e-BlueSM tools within Availity (PDF)

Update: We’re changing how we manage biologic asthma therapies, starting Jan. 1 (PDF)

e-referral system out of service for maintenance overnight Aug. 20-21 (PDF)

Updated Vascular embolization or occlusion (TACE/RFA) questionnaire in the e-referral system (PDF)

We’re changing how we manage Skyrizi SC and Stelara SC, starting Aug. 15 (PDF)

Some members temporarily not found in AIM ProviderPortal® (PDF)

Releuko® to require prior authorization for most commercial members starting Nov. 1 (PDF)

Alymsys® to require prior authorization for most commercial members starting Aug. 25 (PDF)

BCN to use InterQual® ABA criteria for prior authorization requests submitted starting Oct. 1 (PDF)

July 2022

Due to supply shortages, patients shouldn't be started on Wegovy® (PDF)

Three additional medications require prior authorization for Medicare Advantage members, starting Aug. 8 (PDF)

Additional drugs will have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)

Important information about billing and requesting prior authorization for denosumab (PDF)

Questionnaire changes in the e-referral system, starting July 25 (PDF)

Starting Aug. 1, radiology code *71271 won’t require prior authorization for Blue Cross commercial members (PDF)

Amvuttra™ and Skyrizi® IV to require prior authorization for most commercial members starting July 28 (PDF)

Starting Jan. 1, requests for commercial inpatient rehabilitation admissions and extensions must be submitted through e-referral and not by fax (PDF)

We use clinical information to validate providers’ answers to some questionnaires in the e-referral system (PDF)

e-referral system out of service for maintenance overnight July 16-17 (PDF)

Updated: Questionnaire changes in the e-referral system, starting July 10 (PDF)

Some SecureCare® clinical performance reports to be available later than expected (PDF)

Byooviz® to be the preferred ranibizumab drug for Medicare Advantage members starting Oct. 4 (PDF)

June 2022

July 4 holiday closure: How to submit inpatient authorization requests (PDF)

Oxlumo® to have site-of-care requirement for commercial members starting Oct. 1 (PDF)

Improved process for prior authorization requests for initial SNF stays for Medicare Advantage members (PDF)

Post-acute care providers need direct access to naviHealth’s provider portal (PDF)

Availity® administrators: Set up Health e-BlueSM tools within Availity (PDF)

e-referral system out of service on two weekends in June (PDF)

June 20 holiday closure: How to submit inpatient authorization requests (PDF)

Updated: Health e-BlueSM tools: Processing delays for access requests (PDF)

Reminder: Availity® administrators must take action now to ensure access to e-referral and Health e-BlueSM tools within Availity (PDF)

May 2022

Updated: Oral surgery questionnaire to open in e-referral system, starting May 29 (PDF)

Cortrophin® and Ryplazim® will have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)

e-referral Type of Care definitions updated (PDF)

May 30 holiday closure: How to submit inpatient authorization requests (PDF)

Update: We're removing age limits for autism spectrum disorder services (PDF)

e-referral system out of service for maintenance overnight May 21-22 (PDF)

Additional medical benefit drugs to have site-of-care requirements for BCN commercial members starting Sept. 1 (PDF)

Fusilev® will no longer require prior authorization, starting May 31 (PDF)

Fyarro™ to require prior authorization for most members starting Aug. 16 (PDF)

Fyarro™ and Tivdak® will have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)

Update: Inflectra® and Avsola® are the preferred infliximab products for pediatric commercial members starting July 1 (PDF)

Leqvio® to have site-of-care requirement for commercial members starting Aug. 1 (PDF)

Availity® administrators: Set up the e-referral tool within Availity (PDF)

Important news about submitting medical benefit drug prior authorization requests for Medicare Advantage members (PDF)

April 2022

AIM to ask for clinical information for Blue Cross commercial radiology and cardiology prior authorization requests (PDF)

We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members (PDF)

Update: Time frames for determinations on authorization requests for acute inpatient medical admissions (PDF)

Availity® administrators: Ensure access to e-referral and Health e-BlueSM tools within Availity (PDF)

CareCentrix® home health care: HIPPS Questionnaire has been removed for Medicare Plus BlueSM members who receive services in Michigan (PDF)

Prior authorization requirements change for radiology code *71271 (PDF)

Updated: questionnaires to open in the e-referral system starting April 24 (PDF)

Availity® administrators: Set up Health e-BlueSM tools within Availity (PDF)

e-referral system out of service for maintenance overnight April 16-17 portal (PDF)

SecureCare® to manage outpatient PT, OT, ST, physical medicine and chiropractic services for Blue Cross commercial and Medicare Plus Blue, starting July 5 (PDF)

Medicare Advantage post-acute care: New 7-day limit on documents in naviHealth's nH Access™ portal (PDF)

April 15 holiday closure: How to submit inpatient authorization requests (PDF)

Pilot program with TurningPoint supports members’ musculoskeletal care (PDF)

Danyelza™, Margenza® and Saphnelo™ to require prior authorization for URMBT members with Blue Cross non-Medicare plans (PDF)

AIM authorization IDs to include alpha characters starting in April (PDF)

March 2022

Availity® administrators: Set up the e-referral tool within Availity (PDF)

Carvykti™ and Byooviz™ to require prior authorization for commercial members (PDF)

Blue Cross and BCN information now available within Availity Essentials (PDF)

TurningPoint coding requirements for musculoskeletal procedures and related services (PDF)

Update on e-referral news items display

Update: We'll stop accepting faxed requests for commercial SNF admissions starting June 1

Brineura® won’t require prior authorization for URMBT members with Blue Cross non-Medicare plans

Enjaymo™ will have prior authorization and site-of-care requirements for commercial members, starting March 17

Behavioral health resources to discuss with your patients

Kimmtrak® and Tivdak® to require prior authorization for most members starting May 23

e-referral system out of service for maintenance overnight March 19-20

Carvykti™ to require prior authorization for Medicare Advantage members starting March 7

Reminder: Starting March 1, we aligned our Local Rules for acute inpatient medical admissions

Empaveli® and Actemra® to require prior authorization for Blue Cross URMBT non-Medicare members, starting June 1

We're ending the temporary suspension of clinical review requirements for admission to skilled nursing facilities

Outpatient PT, OT services no longer require prior authorization for Medicare Plus BlueSM, starting April 1

We're postponing the authorization requirement for *71271 for BCN members

February 2022

Musculoskeletal procedure authorizations: Reminders for facilities

Submit prior authorization requests for prescription drugs through an ePA tool to avoid processing delays

Enjaymo™, Vabysmo™ and Byooviz® to require prior authorization for Medicare Advantage members

New Mobile cardiac outpatient telemetry questionnaire to open in the e-referral system, starting Feb. 27

CareCentrix HIPPS Questionnaire updates targeted for April for Medicare Plus BlueSM members who receive home health services in Michigan

Nyvepria™ and Rybrevant™ to require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans starting May 16

Leqvio®, Tezspire™ and Vabysmo™ to require prior authorization for commercial members starting in February

e-referral system out >e-referral system out of service for maintenance overnight Feb. 19-20

On Feb. 18, the Utilization Management call center at 1-800-392-2512 will be closed until 1 p.m.

e-referral system unavailable overnight Feb. 11-12

TurningPoint authorizations for musculoskeletal surgical and related procedures are valid for six months

January 2022

Update: Temporary suspension of clinical review requirements continues for admission to skilled nursing facilities from hospitals in certain states

Avsola® and Inflectra® will be the preferred infliximab products for commercial members, starting April 1

Vyvgart™ will have prior authorization and site-of-care requirements for commercial members, starting Jan. 13

Advantages of using the e-referral system for prior authorization requests instead of calling or faxing