Home
Alerts

Provider Alerts

Archived Alerts

February 2025

Claims for Medicare Advantage PPO individual members on NASCO system denying as no authorization on file

Questionnaire changes in the e-referral system starting Feb. 23

We’ll use updated ABA supplemental policy starting April 22

Update: Step therapy won’t be required for Darzalex Faspro

How to obtain CGM products for commercial and Medicare Advantage members

Rebyota and Ryoncil will have additional requirements for most commercial members starting March 31

Trazimera to be preferred trastuzumab product for Medicare Advantage members starting May 12

Avtozma to require prior authorization for most commercial members starting Feb. 20

Ahzantive, Enzeevu, Epysqli and Pavblu to require prior authorization for Medicare Advantage members starting May 1

e-referral system out of service for maintenance overnight February 15-16

Step therapy requirements added for Entyvio, Rystiggo, Vabysmo and Vyvgart and for Medicare Advantage members starting May 1

Finding which procedure codes require prior authorization by TurningPoint

Update: Piasky and Tremfya to have a site-of-care requirement for most commercial members starting June 1

Update: Prior authorization changes for blepharoplasty and percutaneous left atrial appendage closure devices starting Feb. 2

Requesting retroactive authorizations if Carelon displays an incorrect coverage end date for Medicare Plus Blue

January 2025

We’ll no longer require prior authorization for pain management procedures for Medicare Advantage members

Some continuous glucose monitoring products available through participating network pharmacies for commercial members

Evenity to have additional step therapy requirements for Medicare Advantage members starting May 1

New Acute inpatient hospital assessment form for commercial and Medicare Advantage members

We’re changing how we manage Stelara and Stelara biosimilar therapies for most commercial members, starting April 1 and May 1

Continue to answer InterQual Connect questions in the e-referral system while we investigate technical issues

Updated: Simlandi preferred adalimumab product for Blue Cross, BCN commercial members

New Blue Elect Plus HRA POS

Additional drugs to have requirements for Blue Cross commercial URMBT members starting April 16

EviCore category assignments and practitioner performance summaries for PTs and OTs will be available Feb. 3

Submit reconsideration requests for commercial members through the TurningPoint provider portal

Jan. 20 holiday closure: How to submit authorization requests for inpatient admissions

How to enter subscriber/enrollee IDs when submitting electronic prior authorization requests for pharmacy benefit drugs

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

Alhemo to require prior authorization for most commercial members starting Jan. 16

Finding which procedure codes require authorization by Carelon or EviCore

Commercial prior authorization requests submitted through NovoLogix must be submitted through a different application starting April 1

Ryoncil to require prior authorization for most members

©2024 – Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.