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Together With GSK Oncology
To learn more about Together with GSK Oncology, click here

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MSHO Featured Corporate Sponsor Assistance Programs

• ADVANCING Patient Support by ADC Therapeutics
• EAGLE CAN® (Care and Access Network)
• KaryForward®: Patient Support by Karyopharm

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WPS Oncology Related LCD Updates

• Revised Policies / Articles

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WPS Recent Oncology Related News

• Changes to Claims Processing for Non-Physician Practitioners
• Infusion Pumps: Prevent Claim Denials
• Updated Medicare Hot Links

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WPS Educational Offerings

New training opportunities available

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CMS-Medicare

Recent Oncology Related Articles

• Physician Bonuses in Health Professional Shortage Areas
• HCPCS Application Summaries & Coding Decisions
• 2026 Medicare Advantage and Part D Advance Notice
• MLN Matters
• And More

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QPP

• 2025 Specialty Measure Sets
• 2025 MIPS Resources
• Data Submission Open for 2024 Perf ormance Year

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Recent RAC Monitor Article

This edition includes articles on

• 2025 Medicare Auditing: Key Changes & Trends
• How the Govt Could Push People Toward Medicare Advantage
• Coding Challenge: Understanding Underdosing
• Navigating Reclassification from Inpatient to Outpatient Observation

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BCBSM/BCN

Recent Oncology Related News

• OncoHealth Manages Our Oncology Value Management Program
• Updated Medicare Advantage Coverage Policy
• 2025 Medicare Advantage, Part D Formulary Changes

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 1-21-25

• Procrit or Epoetin Class Drugs Maintenance
• BCBSM Below Cost Reimbursement

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Resolved Payer Issues

Last Reviewed/Updated 1-21-25

• 0885 Claims Denied With Reason Code 693
• Procrit or Epoetin Class Drugs Maintenance
• Procrit Denials (693)
• 505(b)(2) Oncology Products Being Impacted by Prior Auth

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Aetna

• January 2025 OfficeLink Update

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Health Alliance Plan

• New HAP 2025 Medicare Advantage Plans
• HAP CareSource Marketplace Plans Coming in 2025
• Benefit Policies, Prior Auth, & Pharmacy Info
• Multifactor Authentication Coming Soon

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Medicaid

• Michigan’s Roadmap to Healthy Communities
• MI Selected by CMS to Participate in Behavioral Health Model

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Priority Health Update

• Virtual Services Billing Updates
• January 30 Billing & Coding Webinar
• HMA Members Have Access to Priority Health’s Network
• New & Updated Billing Policies
• And More

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United Healthcare

• Medical Policy Updates
• Reimbursement Policy Updates
• Clinical Program Drug Step Therapy
• Care Provider Administrative Guide
• And More

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Recent Oncology Related FDA Approvals and Expanded Indications

Daiichi Sanyko & AstraZenca Datroway ® (datopotamab deruxtecan-dlnk)
Amgen Lumakras® (sotorasib)
AstraZeneca Calquence (acalabrutinib)
Pfizer Braftovi® (encorafenib)
BeiGene Tevimbra® (tislelizumab-jsgr)
Bristol Myers Squibb Opdivo Qvantig™ (nivolumab & hyaluronidase-nvhy)

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ASK MSHO

January 2025 Frequently Asked Questions

• Reporting 96376 With 96374
• Coding for IVP Without Stop Time
• ISMP Documentation for Administering Higher-Risk Drugs
• REMS Eligibility For New Car-T Certified Centers
• And More

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