Medicare Plus Blue PPO adding outpatient sites of care to specialty medication prior authorization program, starting Jan. 1

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^SM PPO 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 at our Medicare Advantage PPO medical drug policies and forms webpage.

How to bill
For Medicare Plus Blue, bill specialty medications that require authorization in one of the following ways:

• Electronically through an 837P transaction or on a professional CMS-1500 claim form
• Electronically through an 837I transaction or using a UB04 claim form for a hospital outpatient type of bill 013x

Important reminder
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 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. When complete, fax it to the number listed on the form.

If you need to request access to Provider Secured Services, complete the Provider Secured Access Application and fax it to the number provided on the form.