Medicare Plus BlueSM facility claims for Prolastin® and AralastTM no longer deny for lack of documentation

As of Jan. 28, 2019, Medicare Plus Blue PPO facility claims billed for Prolastin and Aralast (with HCPCS J0256, sent via electronic institutional format 837I or paper UB-04 form) no longer deny for lack of medical documentation. This is regardless of the date of service.

Also, we've begun working on 2019 prior-authorization requirements (for electronic or paper facility claims) for certain specialty medical drugs, including Prolastin and Aralast. We'll share more information about this over the next few months.

Posted: February 2019
Line of business: Blue Cross Blue Shield of Michigan