03/04/2019

BCBSM/BCN

Recent Oncology Related News

Provided by MSHO Managed Care Committee Members:

Medicare Plus Blue PPO manual update coming in April

Blue Cross Blue Shield of Michigan will update its Medicare Plus Blue^SM PPO manual, effective April 1. Key changes include updated language in the following sections:

• Added and updated language in the Billing members section
• Updated language in the Pharmacy treatment improvement opportunities section
• Added and updated language in the Utilization management section

This message serves as notice of these changes to the Medicare Plus Blue PPO manual, per the terms of the Blue Cross Medicare Advantage PPO provider agreement.

Some professional claims receiving front end edit P022 in error

An Internet Claim Tool issue caused some professional claims to receive rejections in error. The issue has been corrected and all claims were resubmitted.

If you submitted professional claims and received edit P022 PAYER ID IS INVALID FOR SOURCE OF PAYMENT on a professional 277CA report with run date February 19, 2019, you can disregard the rejection.

For questions about ICT claims and edit reports, contact the EDI Helpdesk at 800-542-0945, option 1. We apologize for any inconvenience.

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.

March 2019 – Issue

• Rollout of CAQH Direct Assure 2.0 continues in 2019
• Certain infusion drugs won’t be covered in outpatient hospitals, starting April 1
• Improve HEDIS scores through claims coding
• Policy Clarifications DO NOT MISS THIS ARTICLE
  • J9035 - Basic benefit and medical policy - Avastin (bevacizumab)

CHECK OUT THESE ARTICLES AND MUCH MORE HERE!