02/19/2019

BCBSM/BCN

Recent Oncology Related News

Provided by MSHO Managed Care Committee Members:

Processing delay for professional medical drug claims

Blue Cross Blue Shield of Michigan professional medical drug claims will not make this week's check writing cycle. The issue affects claims submitted February 14 - 15, 2019.

Claims will be included in check date February 28, 2019.

We apologize for any inconvenience this may cause.

Start transitioning adult HMO members using infliximab products to Inflectrata

Starting May 1, 2019, Blue Care Network prefers the infliximab product, Inflectra^® (infliximab-dyyb), for its adult BCN HMO^SM commercial members. This change doesn't apply to:

• BCN Advantage^SM members
• Blue Cross Blue Shield of Michigan PPO commercial members
• Pediatric members 15 years old or younger
• Pediatric members 18 years old or younger, weighing 50 kg or less

Please refer to the current medical policy for all criteria, and begin taking steps to:

• Transition adult members with active authorizations for non-Inflectra infliximab products to Inflectra by May 1, 2019.
• Prescribe or fill Inflectra when possible instead of Remicade^® (infliximab) HCPCS code J1745, or Renflexis^® (infliximab-abda) HCPCS code Q5104.
• Bill Inflectra with HCPCS code Q5103.

Quick links to helpful resources

• Current Medical Policy search tool
• Requirements for drugs covered under the medical benefit

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.

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!