For Medicare Plus BlueSM PPO, the Specialty Medication Prior Authorization Program is expanding to include all sites of care except inpatient
For dates of service on or after Jan. 1, 2020, Blue Cross Blue Shield of Michigan will add all outpatient sites of care to the Medicare Plus Blue Specialty Medication Prior Authorization Program. This means you'll need to obtain authorization for specialty medications administered in outpatient sites of care, such as a member's home or an outpatient facility.
This change doesn't affect inpatient sites of care.
You can find a complete list of drugs that require authorization in the Medicare Advantage PPO medical drug policies and forms page of the bcbsm.com website. To open this page:
How to bill
For Medicare Plus Blue, you should bill specialty medications that require authorization in the following manner:
You must obtain an authorization before administering any medication that requires authorization. Use the NovoLogix® online tool to quickly submit your authorization requests. It offers real-time status checks and immediate approvals for certain medications.
If you have a Type 1 (individual) NPI and you checked the "Medical Drug PA" box when you completed the Provider Secured Services Application form, you already have access to NovoLogix. If you didn't check that box, you can complete an Addendum P form to request access to NovoLogix and fax it to the number on the form.
If you need to request access to Provider Secured Services, complete the Provider Secured Services Application form and fax it to the number on the form.
Posted: September 2019
Line of business: Blue Cross Blue Shield of Michigan