Sign up for additional training webinars

Provider Experience is continuing its series of training webinars for health care providers and staff. They’re designed to help you work more efficiently with Blue Cross Blue Shield of Michigan and Blue Care Network.

Here’s a list of webinars and links to register:

As additional training webinars become available, we’ll communicate about them through web-DENIS or The Record.

We’re expanding CAQH ProView 3.0 to include delegated credentialing practitioners

Blue Cross Blue Shield of Michigan is expanding the use of the CAQH ProView 3.0 application. The application will include enrollment demographic and credentialing data for delegated credentialing practitioners.

The purpose of this initiative is to:

• Streamline the data exchange process between delegated practitioner groups and Blue Cross.
• Allow data to be exchanged consistently and more efficiently.
• Improve our provider data quality for our members to view in our directories.

Blue Cross will be accepting automated data feeds from CAQH ProView 3.0 into Portico, our provider data repository. This automated process will make it more efficient for us to maintain provider data and will reduce duplication of data submission for the delegated groups.

We expect to begin beta testing this electronic data exchange with the University of Michigan Medical Group and Genesys PHO for initial enrollment and changes in the first quarter of 2020 and for recredentialing during summer 2020.

Note: We still require signature documents for contracting. Continue to send these documents to the Provider Enrollment and Data Management department.

When billing commercial members, providers can use concurrent billing for some ABA procedure codes

Board-certified behavior analysts are now able to bill for the following applied behavior analysis procedures codes when services are provided to a patient by two providers at the same time:

• *97153 and *97155
• *97154 and *97155

This applies to Blue Cross Blue Shield of Michigan’s PPO (commercial) and BCN HMO^SM (commercial) members.

We updated the Applied Behavior Analysis Billing Guidelines and Procedure Codes document to reflect this change.

To access this document, visit bcbsm.com/providers and log in to Provider Secured Services. Click on web-DENIS on the Provider Secured Services homepage.

Once in web-DENIS, Blue Cross providers can find the document by following these steps:

1. Click on BCBSM Provider Publications and Resources.
2. Click on Newsletters & Resources.
3. Click on Clinical Criteria & Resources.
4. Scroll down and click on Autism under the Resources heading.
5. Click on Applied Behavior Analysis Billing Guidelines and Procedure Codes under the Autism provider resource materials heading.

BCN providers can:

1. Click on BCN Provider Publications and Resources.
2. Click on Autism on the left.
3. Click on Applied Behavior Analysis Billing Guidelines and Procedure Codes under the Autism provider resource materials heading.

We’re streamlining medical record requests for closing gaps in care for HEDIS, star ratings and risk adjustment

A new Blue Cross and Blue Shield Association mandate will help streamline the medical record retrieval process for Blue Cross Medicare Advantage PPO patients nationwide.

Beginning Jan. 1, 2020, Blue Cross Blue Shield of Michigan will manage medical record retrievals for patients who are out-of-area MA PPO group members, in addition to Blue Cross members who live in Michigan. Out of area refers to patients who live in Michigan but are enrolled in another state’s Blue MA PPO plan.

We look forward to working with you and your practice to include this patient population in our current processes. The changes are expected to make the medical record request process simpler for you.

Going forward, health care providers will only receive medical record requests from Blue Cross Blue Shield of Michigan for these out-of-area Blue members. They won’t receive medical record requests from another state’s Blue MA PPO plan.

Blue Cross will work with providers to improve the care of out-of-area patients by:

• Supporting providers with additional information about any open gaps in care related to Medicare star ratings, HEDIS^® or risk adjustment.
• Requesting medical records to ensure Blue plans nationwide have a complete understanding of their members’ health status.

We’ll include more details about this process in a future issue of The Record.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance, or NCQA.

Reminder: Oncology management program effective for MA plans in January

As you read in a September Record article, a new utilization management program for medical oncology drugs for Medicare Plus Blue^SM PPO and BCN Advantage^SM members will begin in January 2020. This program became effective for BCN HMO^SM (commercial) members in August 2019.  

Providers will need to obtain authorizations from AIM Specialty Health^® for some medical oncology and supportive care medications. You can view a list of medications managed by AIM on the Blue Cross or BCN AIM-Managed Procedures page of ereferrals.bcbsm.com. Or you can go directly to the list by clicking here.

Nonclinical provider staff can learn about the new medical oncology program and how to use the AIM ProviderPortal^SM by attending a webinar. To attend a webinar, click on your preferred date and time below and then click Add to my calendar. (If the time displays in Pacific time when you click on the link, simply save it to your calendar and it should automatically change to Eastern time.)

Thursday, Nov. 21, 9 to 10 a.m.
Thursday, Dec. 12, 9 to 10 a.m.
Wednesday, Dec. 18, noon to 1 p.m.
Thursday, Jan. 9, 2020, 9 to 10 a.m.
Wednesday, Jan. 22, 2020, noon to 1 p.m.

Clinicians can learn more about the Oncology Management Program for Blue Cross Blue Shield of Michigan and Blue Care Network on the AIM website by clicking here.**  You can also view a short video — Clinician Overview — Medical Oncology Program** — that describes the need for clinical pathways and how the pathways were developed. Use the password AIMONCOLOGY to access it.

The AIM ProviderPortal^SM will be available on Dec. 16. For information about registering for and accessing AIM ProviderPortal, see the Frequently Asked Questions** page of the AIM website.

We’ve also posted a frequently asked questions document about the Oncology Management Program on erferrals.bcbsm.com. To access it, click here.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

More than 4,700 physicians earn PCMH designation in program’s 11^th year

Blue Cross Blue Shield of Michigan recently designated 4,704 physicians in 1,738 primary care practices statewide as patient-centered medical homes. This is the largest number to earn designation in the program’s 11-year history.

Each year since the designation program began, data has shown that patients in PCMH practices, compared to non-PCMH practices, receive preventive care at higher rates and have fewer emergency room visits and hospital stays. This also results in prevented costs, saving patients money on copayments and coinsurance. In fact, the program has prevented $626 million in claim costs in its first nine years.

In 2019, PCMH-designated practices, compared to non-designated practices, had:

• 29% less adult emergency department visits for common chronic and acute conditions, such as diabetes
• 38% less adult hospital stays for conditions that respond to office-based care
• 12% lower use of high-tech radiology services for adults
• 35% less pediatric emergency department visits for common chronic and acute conditions, such as asthma

PCMH practices offer capabilities and services that patients typically may not find at non-designated practices. For example:

• 24-hour telephone access to the care team
• Coordination of specialist and complementary care
• Patient education, such as how to manage asthma or diabetes
• Test tracking and follow-up, to ensure patients receive needed tests and are informed of results
• Medication review and management
• Connections to community and support services

The PCMH program, part of Value Partnerships, is the foundation of Blue Cross’ collaborative efforts with providers to deliver accessible, high-quality, affordable health care to the people of Michigan. To learn more, go to valuepartnerships.com and click on the Programs tab.

MESSA reprocessing 2019 mental health claims for certain services

MESSA has made retroactive changes to its member copayments for certain mental health services for 2019. As a result of these changes, we’re advising our participating providers that Blue Cross Blue Shield of Michigan will be reprocessing their mental health claims for certain services for the period of Jan. 1 through Dec. 31, 2019. 

This affects the following MESSA Choices and Essentials by MESSA group numbers: BCBSM 71452, 71453; BCS 71538, 71539.

We’re reprocessing these claims because we’ve learned that MESSA members haven’t been charged copayments for some of their mental health or substance use disorder office visits in 2019.

Instead of billing members for these copayments, MESSA has decided to waive them. For members who did pay copayments for these visits, Blue Cross will pay providers the amount of the copayments and the providers will then reimburse affected patients.

All copayments will resume on Jan. 1, 2020, when the MESSA 2020 mental health benefit policy is in effect for the following MESSA Choices and Essentials by MESSA group numbers: BCBSM 71452, 71453; BCS 71538, 71539.

If you have any questions, contact Provider Inquiry.

Encourage follow-up care for mental health, substance use disorder after a patient visits ER

In the United States, 18% of adults and 13% to 20% of children experience mental illness, according to the National Committee for Quality Assurance.

Follow-up care for mental health issues is crucial. It helps to:

• Decrease repeat visits to the emergency room.
• Improve physical and mental function.
• Increase compliance with follow-up instructions.
  

In 2016, NCQA also found that 20.1 million Americans older than age 12 were classified as having a substance use disorder. The study showed timely follow-up care for these individuals helped to reduce:

• Substance use
• Future ER use
• Hospital admissions and length of stay

Follow-up care for FEP^® members
A primary care physician or mental health specialist should be a member’s primary resource for follow-up care. Federal Employee Program^® members have additional resources they can use for follow-up care after a discharge from the emergency room for mental illness or substance use disorder:

• Blue Cross Blue Shield Medical Case Management at 1-800-325-6278
• New Directions Behavioral Health at 1-800-342-5891
• Telehealth services at 1-855-636-1579 or www.fepblue.org/telehealth

For more information, FEP members can contact Customer Service at 1-800-482-3600. All other members should call the Customer Service number on the back of their member ID card.

Value Partnerships Annual Report posted online

The 2018 Value Partnerships Annual Report has been posted online on the Value Partnerships Overview page at bcbsm.com/providers.

It provides highlights from 2018, an overview of some of our key programs and updated statistics. For example:

• Value Partnerships includes approximately 50 statewide programs and initiatives, including 17 Collaborative Quality Initiatives.
• Our Value Partnerships program has helped us avoid $2.2 billion in health care costs.
• Patient-Centered Medical Home practices had a 16% lower rate of adult emergency room visits than non-PCMH practices, according to 2017 program data.
• A total of 93% of all hospital admissions statewide are being sent via real-time notifications to our provider partners — and Blue Cross Blue Shield of Michigan — through our statewide health information exchange. This allows for more responsive follow-up and better population health management for our members.
• Over an 18-month period, opioids administered after surgery have been reduced by 50% with no negative effect on pain control, no decreases in quality outcomes and no decreases in patient satisfaction. 

“This year’s Value Partnerships Annual Report is full of key statistics and outcomes tied to many of our statewide program efforts,” said Tom Leyden, director of Value Partnerships. “The report does a great job of succinctly summarizing the progress being made across Michigan in a very clear and understandable manner. If you want to understand how Blue Cross Blue Shield of Michigan is leading the nation in innovative practice transformation, the annual report provides a great 15-minute read.”

A redesigned website
In other Value Partnerships news, we recently redesigned our Value Partnerships website. The new site is less clinical and more results-oriented, making it suitable for sharing with a broader audience, including customers. Be sure to check it out by clicking here.

Take a survey about our utilization management services

Blue Cross Blue Shield of Michigan and Blue Care Network want to know how satisfied you are with their utilization management services.

Take the Utilization Management Practitioner Satisfaction Survey now.

Encourage your office colleagues — including physicians, nurses and referral coordinators — to take the survey as well. The survey will close on Dec. 31, 2019.

Your feedback will help us improve our processes to better support you as you care for our members.

We’re updating the Locum Tenens Arrangements medical policy

Blue Cross Blue Shield of Michigan is updating the policy guidelines for the Locum Tenens Arrangements medical policy, effective Dec. 1, 2019.

The use of a locum tenens provider, or temporary provider, to deliver medical care in the office of a fully credentialled network provider who is unavailable due to illness, pregnancy, vacation, participation in continuing medical education or being called to active duty as a member of a reserve component of the Armed Forces is an established, longstanding and accepted practice.

Medical policy guidelines:

• Blue Cross will allow services provided by locum tenens providers to be billed under the PIN of the regular provider for up to 60 continuous days.
• If a locum tenens provider is treating Blue Cross PPO members for longer than 60 continuous days, he or she must register with Blue Cross and bill under his or her own PIN. If the locum tenens provider is treating PPO patients for longer than 60 continuous days, he or she must be credentialed in the TRUST network or out-of-network sanctions will be applied to claims. Providers who anticipate providing locum tenens services on a regular basis involving multiple practices (two or more) within a 12-month period should be credentialed in the TRUST network.
• Each covered clinical service (procedure code) delivered by the locum tenens provider under the regular provider’s PIN must be appended with either modifiers Q5 or Q6.
• Locum tenens providers must be licensed in the state in which the service is delivered and must only deliver services within their scope of practice.
• The regular provider will pay the locum tenens provider a per diem or agreed amount and the locum tenens provider won’t bill Blue Cross for the services independently.
• When a physician leaves a group, the locum tenens services may be billed using either the replaced physician’s PIN or the group PIN for up to 60 days.

Affected providers
This policy affects any fully licensed, contracted provider who is eligible for direct reimbursement from Blue Cross.

Refer to the medical policy for additional policy information.

CMS establishes several permanent HCPCS procedure codes

The following HCPCS procedure codes became effective Oct. 1, 2019.

J0122 replaces J3490 when billing for Xerava (eravacycline)
The Centers for Medicare & Medicaid Services has an established permanent procedure code for Xerava (eravacycline).

All services from Aug. 27, 2018, through Sept. 30, 2019, will continue to be reported with procedure code J3490. All services performed on and after Oct. 1, 2019 must be reported with J0122.

Xerava (eravacycline) continues to be covered for the approved FDA indications as established on Aug. 27, 2018. Xerava is a tetracycline class antibacterial indicated for the treatment of complicated intra-abdominal infections in patients 18 years of age and older.

Pharmacy doesn’t require preauthorization for this drug.

J0222 replaces J3490, J3590 and C9036 for facility prior authorization when billing for Onpattro (patisiran)  

CMS has an established permanent procedure code for Specialty Medical Drug Onpattro (patisiran).
 
All services from Aug. 10, 2019, through Sept. 30, 2019, will continue to be reported with code J3490, J3590. All services performed on and after Oct. 1, 2019, must be reported with J0222.

All services from Jan. 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9036. All services performed on and after Oct. 1, 2019, must be reported with J0222.

Prior authorization is required through the Medical Benefit Drug Program for J0222 for all groups unless they opted out of the prior authorization program (professional and hospital outpatient facility SBP 15039).

The National Drug Code is 71336-1000-01.

Bypass prior authorization for all medical drugs procedure codes that require prior authorization submitted by a provider with a $0 charge.

Groups that have opted out of the Medical Benefit Drug Program require manual review.

J1303 replaces J3590 when billing Ultomiris (ravulizumab-cwvz)

CMS has established a permanent procedure code for specialty medical drug Ultomiris (ravulizumab-cwvz).

All services from Dec. 21, 2018, through Sept. 30, 2019, will continue to be reported with code J3590. All services performed on and after Oct. 1, 2019, must be reported with J1303.

All services from July 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9052. All services performed on and after Oct. 1, 2019, must be reported with J1303.

The NDC is 25682-0022-01.

Prior authorization is required through the Medical Benefit Drug Program for J1303 for all groups unless they opted out of the prior authorization program (professional and hospital outpatient facility SBP 15039).

Bypass prior authorization for all medical drugs procedure codes that require prior authorization submitted by a provider with a $0 charge.

Groups that have opted out of the Medical Benefit Drug Program require manual review.

J1943 and J1944 replace J3490 and C9035 facility when billing aripiprazole lauroxil, (aristada initio) and aripiprazole lauroxil, (aristada)

CMS has an established permanent procedure code for aripiprazole lauroxil, (aristada initio) and aripiprazole lauroxil, (aristada).

All services from June 25, 2018, through Sept. 30, 2019, will continue to be reported with code J3490. All services performed on and after Oct. 1, 2019, must be reported with J1943 and J1944.

All services from Jan. 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9035. All services performed on and after Oct. 1, 2019 must be reported with J1943 and J1944.

The NDC is 65757-0500-03.

Pharmacy doesn’t require prior authorization for this drug.

J3111 replaces J3490 and J3590 when billing Evenity (romosozumab-aqqg)

CMS has an established permanent procedure code for specialty medical drug Evenity (romosozumab-aqqg).

All services from April 1, 2019, through Sept. 30, 2019, will continue to be reported with code J3490 and J3590. All services performed on and after Oct. 1, 2019, must be reported with J3111.

The NDCs are 55513-0880-01 and 55513-0880-02.

Prior authorization is required through the Medical Benefit Drug Program for J1303 for all groups unless they opted out of the prior authorization program (professional and hospital outpatient facility SBP 15039).

Bypass prior authorization for all medical drugs procedure codes that require prior authorization submitted by a provider with a $0 charge.

Groups that have opted out of the Medical Benefit Drug Program require manual review.

J9204 replaces J3590 and C9038 when billing Poteligeo (mogamulizumab-kpkc)

CMS has established a permanent procedure code for specialty medical drug Poteligeo (mogamulizumab-kpkc).
 
All services from Aug. 8, 2018, through Sept. 30, 2019, will continue to be reported with code J3590. All services performed on and after Oct. 1, 2019, must be reported with J9204.

All services from Jan. 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9038. All services performed on and after Oct. 1, 2019, must be reported with J9204.

The NDC is 42747-0761-01.

Pharmacy doesn’t require preauthorization for this drug.

HCPCS update: New codes added

The Centers for Medicare & Medicaid Services has added several new codes as part of its quarterly Health Care Procedure Coding System updates. The codes, effective dates and Blue Cross Blue Shield of Michigan’s coverage decisions are below.

Injections

Skin substitutes

Temporary procedures medicine

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.

New resources for your practice: Patient Digital Engagement Toolkit, webinar and tips to improve patient portal usage

This is the second in a series of articles on ways online self-service tools help our members (your patients) be more informed, engaged and satisfied.

Online patient portals, or accounts, are digital tools that offer convenient and timely means of communication between patients and providers. In addition, they streamline administrative tasks, such as patient registrations, check-ins and appointment scheduling.  

However, “Build it and they will come” isn’t a great strategy for engaging patients to use our various online account tools. What works?

Awareness
Patient awareness is necessary before digital self-service tools can deliver better workflows.

We must collaborate to create and foster multiple touchpoints that reach those we serve across the various stages of their health care journeys.

Get started with these new resources
You and your staff can tap into these new patient awareness resources right away for insights on how to improve your own patient portal usage and help our members activate and use their Blue Cross accounts. They include:

• Webinar: Let Us Help You Help Them: Your Patients’ Experience
  You’ll learn the value of patient portals, how to foster and improve patient engagement with portals, and how Blue Cross’ member account streamlines accessibility for your patients and makes more efficient use of your time.
  • 10 to 11 a.m. Thursday, Nov. 14 - Register now.
• Webpage: bcbsm.com/ordertoolkit
  Go there to access the Patient Digital Engagement Toolkit order form. You can also review and order member account registration and Blue Cross mobile app materials.

5 tips for improving patient portal engagement

1. Mention the portal in your on-hold messaging and voicemail recordings. Include features they’ll enjoy and how to sign up. Emphasize conveniences, such as 24/7 ability to schedule appointments, request medications or review reports.
2. Put flyers and posters where patients are waiting for appointments and have time to read.
3. Add a tagline on appointment cards, statements and newsletters, such as: “Tired of playing phone tag? Sign up for our patient portal.”
4. Include your portal registration details in checkout materials.
5. Put a link to your patient portal login at the top of your practice website homepage.

Online visits available to MPSERS members with Medicare Plus Blue starting in January

Beginning Jan. 1, 2020, our Medicare Plus Blue^SM plan will offer Blue Cross Online Visits^SM to Michigan Public School Employee Retirement System group members.

Members who use this benefit can virtually connect with a physician, therapist or other health care provider, using a:

• Smartphone
• Tablet
• Computer with a web camera
• Video conferencing device

This service provides our members with:

• A convenient way to get treatment at any time for non-emergency care when their doctor is unavailable or when they’re traveling. (Note: Blue Cross Online Visits available in all 50 states.)
• A psychiatrist or therapist, by appointment, to help manage anxiety, depression, grief and other issues.

Let your patients know how they can sign up for online visits:

• Download the BCBSM Online Visits^SM app through the App Store^®** or Google Play^TM.**
• Visit bcbsmonlinevisits.com.
• Call 1-844-606-1608.

Online visits aren’t intended to replace the doctor-patient relationship. The service is another way for members to seek treatment for minor illnesses when their doctor’s office is closed, it’s late or they’re running short on time. When members use online visits, they should share their visit summary with their primary care doctor.

For more information, read our policy paper on online visits.

**The Apple App Store^® is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC.

Billing chart: Blues highlight medical, benefit policy changes

You’ll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart.

This billing chart is organized numerically by procedure code. Newly approved procedures will appear under the New Payable Procedures heading. Procedures for which we have changed a billing guideline or added a new payable group will appear under Updates to Payable Procedures. Procedures for which we are clarifying our guidelines will appear under Policy Clarifications. New procedures that are not covered will appear under Experimental Procedures.

You will also see that descriptions for the codes are no longer included. This is a result of recent negotiations with the AMA on use of the codes.

We will publish information about new BCBS groups or changes to group benefits under the Group Benefit Changes heading.

For more detailed descriptions of the BCBSM policies for these procedures, please check under the Medical/Payment Policy tab in Explainer on web-DENIS. To access this online information:

• Log in to web-DENIS.
• Click on BCBSM Provider Publications & Resources.
• Click on Benefit Policy for a Code.
• Click on Topic.
• Under Topic Criteria, click on the drop-down arrow next to Choose Identifier Type and then click on HCPCS Code.
• Enter the procedure code.
• Click on Finish.
• Click on Search.

Sign up for additional training webinars

Provider Experience is continuing its series of training webinars for health care providers and staff. They’re designed to help you work more efficiently with Blue Cross Blue Shield of Michigan and Blue Care Network.

Here’s a list of webinars and links to register:

As additional training webinars become available, we’ll communicate about them through web-DENIS or The Record.

When billing commercial members, providers can use concurrent billing for some ABA procedure codes

Board-certified behavior analysts are now able to bill for the following applied behavior analysis procedures codes when services are provided to a patient by two providers at the same time:

• *97153 and *97155
• *97154 and *97155

This applies to Blue Cross Blue Shield of Michigan’s PPO (commercial) and BCN HMO^SM (commercial) members.

We updated the Applied Behavior Analysis Billing Guidelines and Procedure Codes document to reflect this change.

To access this document, visit bcbsm.com/providers and log in to Provider Secured Services. Click on web-DENIS on the Provider Secured Services homepage.

Once in web-DENIS, Blue Cross providers can find the document by following these steps:

1. Click on BCBSM Provider Publications and Resources.
2. Click on Newsletters & Resources.
3. Click on Clinical Criteria & Resources.
4. Scroll down and click on Autism under the Resources heading.
5. Click on Applied Behavior Analysis Billing Guidelines and Procedure Codes under the Autism provider resource materials heading.

BCN providers can:

1. Click on BCN Provider Publications and Resources.
2. Click on Autism on the left.
3. Click on Applied Behavior Analysis Billing Guidelines and Procedure Codes under the Autism provider resource materials heading.

Reminder: Oncology management program effective for MA plans in January

As you read in a September Record article, a new utilization management program for medical oncology drugs for Medicare Plus Blue^SM PPO and BCN Advantage^SM members will begin in January 2020. This program became effective for BCN HMO^SM (commercial) members in August 2019.  

Providers will need to obtain authorizations from AIM Specialty Health^® for some medical oncology and supportive care medications. You can view a list of medications managed by AIM on the Blue Cross or BCN AIM-Managed Procedures page of ereferrals.bcbsm.com. Or you can go directly to the list by clicking here.

Nonclinical provider staff can learn about the new medical oncology program and how to use the AIM ProviderPortal^SM by attending a webinar. To attend a webinar, click on your preferred date and time below and then click Add to my calendar. (If the time displays in Pacific time when you click on the link, simply save it to your calendar and it should automatically change to Eastern time.)

Thursday, Nov. 21, 9 to 10 a.m.
Thursday, Dec. 12, 9 to 10 a.m.
Wednesday, Dec. 18, noon to 1 p.m.
Thursday, Jan. 9, 2020, 9 to 10 a.m.
Wednesday, Jan. 22, 2020, noon to 1 p.m.

Clinicians can learn more about the Oncology Management Program for Blue Cross Blue Shield of Michigan and Blue Care Network on the AIM website by clicking here.**  You can also view a short video — Clinician Overview — Medical Oncology Program** — that describes the need for clinical pathways and how the pathways were developed. Use the password AIMONCOLOGY to access it.

The AIM ProviderPortal^SM will be available on Dec. 16. For information about registering for and accessing AIM ProviderPortal, see the Frequently Asked Questions** page of the AIM website.

We’ve also posted a frequently asked questions document about the Oncology Management Program on erferrals.bcbsm.com. To access it, click here.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Reminder: Payment methodology updated for MA admissions to skilled nursing facilities

As we previously announced, Medicare Plus Blue^SM PPO and BCN Advantage^SM have changed their payment methodology for skilled nursing facilities. As of Oct. 1, 2019, the payment methodology changed from resource utilization group levels to patient-driven payment model levels during the patient’s stay (from preservice through discharge).

This update to the payment methodology:

• Applies to skilled nursing facility admissions with dates of service on or after Oct. 1, 2019
• Aligns with the Centers for Medicare & Medicaid Services’ payment methodology for skilled nursing facilities

As a reminder, naviHealth manages authorization requests for Medicare Plus Blue PPO and BCN Advantage members admitted to post-acute care on or after June 1.

When submitting claims for stays with dates of service starting on or before Sept. 30, 2019, and extending through or beyond Oct. 1, 2019, you need to include both the RUG levels and the PDPM levels that naviHealth authorized.

For more information, review:

• The Patient Driven Payment Model (PDPM) — Information and Resources for Provider Partners**
• Post-acute care services: Frequently asked questions for providers

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

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.

Blue Cross and BCN to cover select hyaluronic acid products, starting Jan. 1

Effective Jan. 1, 2020, Blue Cross Blue Shield of Michigan and Blue Care Network will consider the following hyaluronic acid products to be either covered or preferred under the medical benefit:

• Durolane^®
• Euflexxa^®
• Gelsyn-3^™
• Supartz FX^™

Starting Jan. 1, the following will be considered either noncovered or nonpreferred hyaluronic acid products:

• Gel-one^®
• GenVisc 850^®
• Hyalgan^®
• Hymovis^®
• Monovisc^®
• Orthovisc^®
• Synvisc^®
• Synvisc-One^®
• TriVisc^®
• Visco-3^™
• Synojoynt^™
• Triluron^™

This change will apply to Blue Cross’ PPO, Medicare Plus Blue^SM PPO, BCN HMO^SM and BCN Advantage^SM members. This change won’t apply to self-funded General Motors, Fiat Chrysler Automobiles, Ford Motor Company and UAW Retiree Medical Benefit Trust commercial groups.

Blue Cross’ PPO and BCN HMO commercial members

• Members who began receiving noncovered hyaluronic acid products before Jan. 1, 2020, can continue their treatment courses to completion. For future treatment courses that begin on or after Jan. 1, 2020, we encourage providers to talk to their patients about using a covered hyaluronic acid product.
• For treatment courses that begin on or after Jan. 1, 2020, we’ll require members to use a covered hyaluronic acid product. These products don’t need prior authorization.
• We’ll deny claims for noncovered hyaluronic acid drugs.
• We’ll notify affected members of these changes and encourage them to discuss treatment options with you.

Medicare Plus Blue and BCN Advantage members

• Members who began receiving nonpreferred hyaluronic acid products before Jan. 1, 2020, can continue their treatment courses to completion. For future treatment courses that begin on or after Jan. 1, 2020, we encourage providers to talk to their patients about using a preferred hyaluronic acid product.
• For treatments on or after Jan. 1, 2020, we’ll require members to use preferred hyaluronic acid products. These products won’t need prior authorization. If you select a nonpreferred hyaluronic acid product for a member, you’ll have to obtain prior authorization.

Additional information

The U.S. Food and Drug Administration has approved 16 hyaluronic acid products. To date, no study has shown that one hyaluronic acid product is superior to others.