Archives 2021




December 2021

Cortrophin™ requires prior authorization for commercial members, starting Feb. 24

Updated TurningPoint Documentation Guideline for musculoskeletal procedures and related services

Updated questionnaires to open in the e-referral system, starting Dec. 19

Local rules for acute inpatient medical admissions won't change until March 1, 2022, for all members

Reminder: Starting Jan. 1, requests for commercial SNF admissions must be submitted through e-referral and not by fax

December holiday closures: How to submit inpatient authorization requests

In March, AIM Specialty Health® to update clinical guidelines for prostate cancer imaging

Ryplazim® to require prior authorization for Medicare Advantage members, starting Jan. 17

Medicare Advantage post-acute care: New 30-day limit on documents in naviHealth's nH Access™ portal

Behavioral health resources to discuss with patients

Additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, starting March 10

e-referral system out of service overnight Dec. 18-19 and possible performance issues Jan. 1-3

Assistance is available for post-acute care placements

Starting March 1, radiology procedure code *71271 requires prior authorization for most members

Overview of care management and utilization management programs now available

We've improved the commercial Blue Cross and BCN utilization management medical drug list

New and updated preview questionnaires and medical necessity criteria for the prior authorization program expansion, which begins Jan. 1

Urgent request: Contact us if you can offer behavioral health appointments for members affected by the Oxford High School tragedy

November 2021

Changes to the prior authorization list for medical benefit drugs for Medicare Advantage members

Clarifications on the CareCentrix home health care program for Medicare Advantage members

Changes to the medical oncology prior authorization list for URMBT members with Blue Cross non-Medicare plans, starting Feb. 21

Updated Bone-anchored hearing aid questionnaire to open in the e-referral system, starting Nov. 28

Nov. 25-26 holiday closures: How to submit inpatient authorization requests

e-referral system out of service for maintenance overnight Nov. 20-21

AIM Specialty Health® technical issue is resolved

Susvimo™ requires prior authorization for commercial members, starting Nov. 18

Additional autism interventions now payable via telemedicine on an ongoing basis and restrictions are removed from protocol modification (*97155)

Intensive outpatient program and partial hospital program services now payable via telemedicine on an ongoing basis

Behavioral health services delivered via synchronous telemedicine

October 2021

Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 27

Due date extended for resubmitting some corrected SNF claims for Medicare Plus BlueSM members

Starting Oct. 24, updated questionnaire to open in the e-referral system

Update: CADC and CAADC credentials not required for facilities that treat substance use disorders

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

Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 3

Prior authorization requirements expanding for Medicare Plus Blue, BCN commercial and BCN AdvantageSM members on Jan. 1

TurningPoint to review sites of care for total hip and knee surgeries for some members, starting Jan. 3

AIM Specialty Health® delays are resolved

AIM to ask for clinical information for BCN commercial radiology and cardiology prior authorization requests starting Jan. 1

September 2021

Starting Dec. 27, additional drugs require prior authorization for URMBT members with Blue Cross non-Medicare plans

Nexviazyme™ and Saphnelo™ will have prior authorization and site-of-care requirements for commercial members, starting Sept. 24

Clinical review requirements suspended for admission to skilled nursing facilities from all Michigan hospitals due to latest COVID-19 surge

Starting Sept. 26, new questionnaires to open in the e-referral system

CareCentrix® home health care program: Updated training resources, new and updated documents available

e-referral system out of service for maintenance overnight Sept. 18-19

Ryplazim® requires prior authorization for commercial members starting Sept. 17

Darzalex Faspro™, Polivy™ and Trodelvy™ require prior authorization for URMBT members with Blue Cross non-Medicare plans, starting Dec. 3

Panzyga® will no longer have requirements through NovoLogix® for URMBT members with Blue Cross non-Medicare plans, starting Sept. 3

New BCN rider for large groups in the Upper Peninsula will limit coverage outside Michigan

TurningPoint to allow additional substitutions for orthopedic procedure codes

Saphnelo™ and Nexviazyme™ to require prior authorization for Medicare Advantage members

August 2021

How to submit prior authorization requests for drugs that are managed by AIM when the drugs are prescribed for non-oncology diagnoses

Sept. 6 holiday closure: How to submit inpatient authorization requests

Starting Aug. 29, updated questionnaires to open in the e-referral system

New TurningPoint Documentation Guideline for musculoskeletal procedures and related services

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

Cosela™ and Libtayo® to require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1

Additional drugs require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1

July 2021

Rybrevant™ requires prior authorization for dates of service on or after Sept. 27 for most members

Asparlas™ to require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1

Starting July 25, we'll use clinical information to validate providers' answers to some questionnaires in the e-referral system

Starting July 25, updated questionnaires to open in the e-referral system

Musculoskeletal surgeries and related procedures: New steps for determining whether prior authorization is required for Blue Cross commercial members

CareCentrix®-assigned HIPPS codes for home health services for Medicare Plus BlueSM members who receive services in Michigan

Enteral nutrition questionnaire updated in the e-referral system

Medicare Advantage home health care: Clarifications about adding disciplines and substituting services provided by clinicians with lower-level credentials

AIM Specialty Health® technical issues are resolved

Some denied SNF claims for Medicare Plus Blue members will automatically process for payment after Nov. 26, 2021

Here's how to choose the correct servicing provider in e-referral to avoid denied claims

Aduhelm™ to require prior authorization for commercial members starting July and August

June 2021

July 5 holiday closure: How to submit inpatient authorization requests

Updated pain management questionnaires and Postservice change request form for submitting requests to TurningPoint coming in July

Starting June 27, updated questionnaires to open in the e-referral system

Empaveli™ to require prior authorization for commercial members starting June and August

Aduhelm™, Empaveli™ and Arcalyst® to require prior authorization for Medicare Advantage members

Procedure codes *70554 and *70555 to require prior authorization from AIM starting Sept. 1 for Blue Cross commercial and Medicare Plus BlueSM members

Additional enhancements to the TurningPoint musculoskeletal surgical quality and safety management program

Four additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, for dates of service on or after Sept. 7

May 2021

On May 9, we updated three additional questionnaires in the e-referral system

May 31 holiday closure: How to submit inpatient authorization requests

Jemperli™ and Zynlonta™ require prior authorization for dates of service on or after July 26, 2021, for most members

We're using updated utilization management criteria for non-behavioral health services starting Aug. 2, 2021

We're using updated utilization management criteria for behavioral health services starting Aug. 2, 2021

For Medicare Advantage inpatient admissions, submit prior authorization requests for CAR-T cell therapy drugs to NovoLogix

Criteria used to make determinations on authorization requests for musculoskeletal procedures

Use the correct HCPCS code for Spravato®

e-referral system out of service on two weekends in May

Starting May 9, new and updated questionnaires in the e-referral system

April 2021

CareCentrix® home health care training and resources are now available

Issue resolved: Medical oncology drug claims were denying in error even with authorization from AIM

Updated Medicare local coverage determination for facet joint injections for Medicare Plus BlueSM and BCN AdvantageSM members, starting April 25, 2021

Abecma® to require prior authorization for commercial members starting April and May

Alacura's telephone number has changed, for non-emergency air transport of commercial members

Register for webinar training for the CareCentrix home health care program

Determining whether to submit prior authorization requests for musculoskeletal procedures to TurningPoint for Blue Cross commercial members

Spravato® and Panzyga® to require prior authorization starting July 12 for URMBT PPO non-Medicare members

Nulibry™ to require authorization for commercial members

Clinical review requirements suspended for admission to skilled nursing facilities from certain hospitals at higher inpatient bed occupancy

Updated clinical documentation requirements for musculoskeletal procedures

e-referral system out of service for maintenance overnight April 17-18

Providers must submit musculoskeletal authorization requests to TurningPoint for URMBT non-Medicare members

Update: Don’t use F codes when requesting prior authorization for inpatient medical admissions

Abecma™ to require prior authorization for Medicare Advantage members starting April 5

Additional medications will require prior authorization for most members starting May 24

Do's and don'ts when submitting commercial SNF requests using the e-referral system

March 2021

April 2 holiday closure: How to submit inpatient authorization requests

Starting this summer, some prior authorization requests for hyperbaric oxygen therapy will pend for clinical review

Code substitutions available for musculoskeletal surgical procedures authorized by TurningPoint

Starting in June, additional medical benefit drugs will require prior authorization for some Blue Cross commercial members

Starting March 28, new and updated questionnaires in the e-referral system

Amondys 45™ and Evkeeza™ will require authorization for commercial members

Update: Changes coming to preferred products for drugs covered under the medical benefit for most members, starting April 1

Additional medications will require prior authorization for Medicare Advantage members, starting June 22

Easier access to RC Claim Assist

AIM Specialty Health® technical issues are resolved

e-referral system out of service for maintenance overnight March 20-21

Save time: Don't fax unnecessary information about inpatient stays

Starting in June, we'll use clinical information to validate providers' answers to some questionnaires in the e-referral system

Starting June 1, Blue Cross and BCN will cover only preferred hyaluronic acid products for GM, FCA and Ford commercial groups

eviCore will no longer mail Practice Profile Summaries and category information for outpatient physical therapy services starting in July

COVID-19 testing reminders and at-home testing

February 2021

Starting in May, additional medical benefit drugs will require prior authorization for some Blue Cross commercial members

Starting Feb. 28, a new questionnaire will open in the e-referral system for the pediatric feeding program for BCN commercial members

Starting Feb. 28, a new questionnaire will open in the e-referral system for procedures by providers who aren’t contracted with BCN

eviCore healthcare® will accept retroactive authorization requests for musculoskeletal procedures through April 30

e-referral system out of service for maintenance overnight Feb. 20-21

Breyanzi® to require prior authorization for Medicare Advantage members starting Feb. 11

Cardiac rehabilitation 2 questionnaire for BCN AdvantageSM will be removed from the e-referral system on Feb. 7

Updated questionnaire available in the e-referral system on Feb. 7

How to submit appeals of Medicare Advantage inpatient acute care admissions

Cardiology procedure code *33208 doesn't require authorization for most members

January 2021

Medical benefit specialty drug prior authorization list changing in April for most members

We're adding site-of-care requirements for Uplizna® for Blue Cross commercial members, starting Jan. 1, 2021

Radiology procedure code *71271 doesn’t require authorization for most members

AIM Specialty Health® call center closed on Jan. 18 holiday

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

January holiday closure: How to submit inpatient authorization requests

Reminder: Submit prior authorization requests to TurningPoint for musculoskeletal procedures for most members

Check for messages in e-referral to expedite your requests