02/05/2019

BCBSM/BCN

Recent Oncology Related News

Provided by MSHO Managed Care Committee Members:

Prior-authorization changes coming to AIM authorization program

Beginning May 1, 2019, the PPO radiology management program, administered by AIM Specialty Health, will be adding a cardiology and in-lab sleep study prior authorization program for Medicare Plus Blue^SM PPO members. AIM is also adding prior authorization procedure codes for its high-tech radiology breast MRI program.

Please note that UAW Retiree Medical Benefits Trust members with Medicare Plus Blue coverage are also included in this program.

For more details please see the February Record article.

Request authorization through AIM's ProviderPortal or call 1-800-728-8008.

Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization

The following Blue Cross Blue Shield of Michigan PPO groups don't need AIM Specialty Health prior authorization for any medical diagnostic service:

• 70605 UAW Retiree Health Care Trust
• 71714 UAW International Union

Friendly reminder
As you're checking eligibility and benefits for your patients, please make sure to review the authorization requirements. Benefit Explainer will let you know if the service requires authorization when you enter the patient's contract number and service procedure code.

2019 Medicare Plus BlueSM claims processed with 2018 rates

All Medicare Plus BlueSM claims we received on or after Jan. 7, 2019, for dates of service between Jan. 1 through Jan. 6, 2019, were processed at 2018 rates. We'll reprocess these claims within the next 10 to 15 days.

This doesn't affect Part D claims.

Additional fee schedules added to web-DENIS

Blue Cross Blue Shield of Michigan recently added the following "entire fee schedules" to web-DENIS, reflecting fee updates effective February 1, 2019:

Professional: Injection Fee Schedule

• Injections minimum fee schedule (2/01/2019)

Note: Effective for dates of service on or after 2/1/14, professional providers, who want accurate payment at the NDC level, are requested to also provide the NDC and NDC quantity when submitting an injection HCPCS code and HCPCS quantity. Otherwise, the claim will be priced at the minimum fee, which is displayed in the professional fee schedule listed above.

Facility: Hospital Outpatient

• Drug fees effective 02/01/2019

These and other fee schedules are available on web-DENIS under BCBSM Provider Publications and Resources selecting Entire Fee Schedules and Fee Changes.

February 11, 2019 ICT Webinar: You've submitted a few claims; now what?

Have you submitted a few claims, but need help with the next step? If so, join us for an Internet Claim Tool webinar on Monday, February 11, 2019, from 10 a.m. to 11 a.m. This webinar is designed for new professional ICT users. We will focus on how to assign claims to a new payer; the Payer Response Report; viewing transmitted claims; and resending edited claims. Please note attendees should have already submitted claims; this session is not intended as a first-time user's tutorial.

If you would like to participate, please click here to send an email with your first and last name, web-DENIS ID, company name, billing NPI and unique email address information to  edicustmgmt@bcbsm.com. We will supply login details prior to the training session.

EDI Customer Management

NASCO conducting payment recovery for General Motors

On Jan. 16, 2019, NASCO will begin a payment recovery for incorrect rejections of GM group, professional chemotherapy office visit claims. The recovery includes:

• CPT codes *99211 through *9915 with specific chemotherapy diagnosis
• B422 — Your patient's health care coverage doesn't pay for this service for the reported diagnosis. The subscriber is liable for your charge.
• M620 — Chemotherapeutic agent
• M718 — Payment for this service was included in a previously paid service
• Claims made between Jan. 1, 2017 through Oct. 11, 2018

We're currently reprocessing these claims. When you're adjusting your patients' accounts with the correct payment the subscriber may become liable for the charge.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.

Payment recovery, rebilling advice for incorrect 340B modifier drug claims

Effective immediately, Blue Cross Blue Shield of Michigan will recover full payments for Medicare Plus BlueSM PPO drug claims that were sent to us with the incorrect 340B program modifier (TB*).

Reminder

You must use the JG* modifier for drugs acquired through the 340B program for facilities not designated as a rural (sole-community) hospital, children's hospital or a Prospective-Payment-System-exempt cancer hospital.

Please correct your claims and resubmit them using the proper modifier, according to Medicare guidelines.

References

Medicare Claims Processing Manual, chapter 17, "Drugs and Biologicals," section 90.2.E "Biosimilars"

Medicare-Fee-For-Service Program Billing 340B Modifiers under the Hospital Outpatient Prospective Payment System (OPPS) Frequently Asked Questions

Medicare Plus Blue PPO drug administration coding

Blue Cross Medicare Plus BlueSM has found many examples of claims for non-chemotherapy drugs submitted with a chemotherapy administration code. Effective immediately, Blue Cross will recover the full payment when chemotherapy administration codes are submitted in error.

How to correct these claims
You can submit a corrected claim using the appropriate non-chemotherapy administration code (in accordance with Wisconsin Physicians Service Insurance Corporation, Article A54176).

If the chemotherapy administration was quantity-billed because multiple drugs (chemotherapy and non-chemotherapy) were provided during the same visit, submit a corrected claim separating out the administration-unit billed for the chemotherapy drug and the administration unit that shouldn't be billed with the non-chemotherapy administration code.

Refer to Wisconsin Physicians Service Insurance Corporation Article A54176.

For billing code J2357
Per Local Coverage Determination 34741 billing and coding guidelines, it isn't appropriate to bill more than one unit for the administration code regardless of the number of vials or syringes used for Xolair.

February 2019 – Issue

• HCPCS replacement codes established
• HEDIS medical record reviews begin in February
• Here’s what you need to know about medical record reviews

CHECK OUT THESE ARTICLES AND MUCH MORE HERE!