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MSHO Featured Corporate Sponsor Assistance Programs

• Amgen SupportPlus
• Genmab's MyNavCare Patient Support
• Taiho Oncology Patient Support

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WPS Oncology Related LCD Updates

• Revised Policies / Articles

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WPS Recent Oncology Related News

• HCPCS Code Update
• Determining Payment for Services
• Prevent Claim Denials
• Medicare Hot Links
• And More

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WPS Educational Offerings

New training opportunities available

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CMS-Medicare

Recent Oncology Related Articles

• Actions to Make Healthcare Prices Transparent
• Medicare Shared Savings Program
• Correcting Error to Code C1739
• MLN Matters
• And More

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QPP

New 2025 Quality Benchmarks & Other Resources

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Recent RAC Monitor Article

This edition includes articles on

• Understanding Extrapolation in Healthcare Billing and Coding Audits
• Why is the Hottest Topic Not Included in the No Surprises Act
• Taking the Pain out of Pain Coding – Part I
• Taking the Pain out of Pain Coding – Part II

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BCBSM/BCN

Recent Oncology Related News

• HCPCS Codes Delayed
• Changes to the Oncology Value Management Program
• Bill With Correct Prefixes and Contract Numbers for Dates of Service
• Medicare Plus Blue HCFA-1500 Claims
• And More

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BCBSM/BCN

Publications

• Blues Brief
• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 3-19-25

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

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Resolved Payer Issues

Last Reviewed/Updated 3-17-25

• 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

• Spring 2025 Provider Newsletter
• March 2025 OfficeLink Update

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Health Alliance Plan

• Extension of Telehealth Services Inpatient Admissions Criteria
• Inpatient Admissions Criteria
• Update - Payment of Observation Hospital Stays
• Keep Provider Information Updated in NPPES

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Molina

Recent Oncology Related News

• Provider Bulletin

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Priority Health Update

• Telemedicine / Virtual Services Billing Update
• Updated 2025 PCP Incentive Program (PIP) Manual
• Pontiac General Hospital No Longer Part of Priority Health Network
• Collecting Medical Records For Medicare Retrospective Review
• And More

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United Healthcare

• Medical Policy Updates
• Reimbursement Policy Updates
• Pharmacy and Clinical Updates
• Specialty Medical Injectable Drug Program Updates 

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Recent Oncology Related FDA Approvals and Expanded Indications

Merck Keytruda (pembrolizumab)
BeiGene Tevimbra® (tislelizumab-jsgr)

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Drug Updates

• FDA Approved Incyte & Syndax's Niktimvo™ (axatilimab-csfr) 9 mg and 22 mg Vial Sizes

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ASK MSHO

March 2025 Frequently Asked Questions
From MSHO & WPS Outpatient Reimbursement Webinar

• Billing for Alternative Dosing for Xgeva
• Telemedicine Billing after 3-31-25
• G2211 Services
• Contacting MUE
• And More

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