The Record

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August 2019
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Reminder: Providing services to patients in an out-of-state MA PPO plan
Each year, we like to remind our health care providers about Medicare Advantage PPO network sharing for Blue Cross Blue Shield plans. Network sharing allows patients to see any Medicare Advantage PPO provider across the country and obtain in-network benefits. Read more.

Inside this issue for you

Providers must get appropriate consent to share patient information
State of Michigan group to carve in behavioral health and substance use disorder services
Blue Cross expands pilot program to promote pain control through limiting post-operative opioid dispensing

See all the articles in this issue, grouped by category, below.

Professional

Save the date: You’re invited to a Stars Premiere event near you
HEDIS measure tip sheets updated for 2019
Blue Cross, BCN offering innovative insulin management program to qualifying members
Sign up for additional training webinars
Commercial audits of DME, HIT and HCD claims taking place
We’re changing categorization process for physical therapy
List top locations when updating your information with CAQH
We’ll add more vaccines to pharmacy benefit Aug. 1
Immune, subcutaneous globulin dosing strategy changing
Kenalog Spray and oral inhalers will have new quantity limits starting Sept. 1
Coding corner: Coding and documentation for COPD
Study identifies barriers to statin therapy adherence

All Providers

Reminder: Providing services to patients in an out-of-state MA PPO plan
Providers must get appropriate consent to share patient information
State of Michigan group to carve in behavioral health and substance use disorder services
Blue Cross expands pilot program to promote pain control through limiting post-operative opioid dispensing
Battling the opioid epidemic: A roundup of recent news and information
Medicare Plus Blue will begin reporting qualified Medicare beneficiaries’ eligibility on applicable claim lines
NaviNet handling Blue Cross Complete eligibility and claims inquiries beginning in August
HCPCS update: New codes added
Billing chart: Blues highlight medical, benefit policy changes

Facility

We’re making changes to the Medicare Advantage SNF post‑payment audit, recovery process
We’ll be starting Medicare Plus Blue readmission audits in September
Commercial audits of DME, HIT and HCD claims taking place
We’re changing categorization process for physical therapy

Pharmacy

We’ll add more vaccines to pharmacy benefit Aug. 1
Immune, subcutaneous globulin dosing strategy changing
Kenalog Spray and oral inhalers will have new quantity limits starting Sept. 1

DME

Commercial audits of DME, HIT and HCD claims taking place

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