10/02/2018
BCBSM/BCN
Recent Oncology Related News
Provided by MSHO Managed Care Committee Members:
October 18, 2018 ICT Webinar: You've submitted a few claims; now what?
Have you submitted a few claims, but needhelp with the next step? If so, join us for an Internet Claim Tool webinar on Thursday, October 18, 2018, 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.
Medical records requests will begin for commercial initiatives, Oct. 2018
In Oct. 2018, Ciox Health will begin requesting medical records for commercial patients. Ciox may ask for your help to provide complete medical records for your list of patients who were treated in your office in 2018.
The Centers for Medicare & Medicaid Services requires that Blue Cross and BCN satisfy standards for patient data submission and diagnosis coding accuracy. This medical record review is to confirm that we're meeting CMS and Department of Health and Human Services' requirements.
If you have questions, please contact one of the following Blue Cross and BCN provider consultants:
- Tom Rybarczyk, 313-378-8259
- Corinne Vignali, 313-969-0417
- Sue Brinich, 586-839-8614
UPDATE: Magellan claims receiving edit error for invalid payer ID 01260
The issue causing the error 'Payer Identification Number - Invalid Code' to appear on claims for Magellan with the payer ID 01260 has been resolved. Once users view the claims, and save and run edits, the edit is removed.
We apologize for any inconvenience this may have caused.
Updates to PPO professional, outpatient claim editing process coming in December
Starting in December 2018, Blue Cross Blue Shield of Michigan will update its professional and outpatient facility PPO claim editing processes for select groups.
These improvements will make our claims payment system easier for you and your billing staff to navigate. Unique clinical editing reason codes will appear on the 835 response files or provider vouchers.
As a reminder
Health care providers affiliated with the PPO network agree to supply services to Blue Cross members and bill according to guidelines and requirements set by the American Medical Association and select specialty societies.
If you have questions about our claim editing process, please call Provider Inquiry:
Professional — 1-800-344-8525
Facility — 1-800-249-5103
Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased
Some health care providers have questioned what to do when billing certain medical drugs that were administered by a medical professional but supplied by our specialty pharmacy.
Here are guidelines to follow in professional and hospital settings:
- When professional providers administer a drug they didn’t purchase, they should bill for the administration code only and not include the drug or NDC code on the claim.
- When professional providers administer a medical drug that was purchased, notes should be documented and a copy of the purchase order included in the member’s chart.
- Identical NDC codes billed within 14 days of a specialty pharmacy claim will be recovered and the provider will need proof of purchase to have the claim repaid.
- When a hospital administers a drug in an outpatient setting that isn’t purchased by the hospital, the hospital should bill for the administration. However, the hospital should include the revenue code and corresponding procedure code for the medical drug with total charges of $.01.
For more information, see the May 2016 and July 2016 Record articles.
Phone numbers change for BCN Case Management and Care Transition programs
The phone numbers for BCN's Case Management and Care Transition to Home programs have changed. To reach staff in these programs, call 1-800-775-2583. Wait to hear the prompts and press the number for the prompt that matches your request.
Please update your files to show the following:
- Instead of the 1-800-943-9744 number for BCN Case Management, call 1-800-775-2583.
- Instead of the 1-800-728-3010 number for the BCN Care Transition to Home program, call 1-800-775-2583.
The Care Management and BCN Advantage chapters of the BCN Provider Manual are being updated to reflect the new 1-800-775-2583 phone number.
National drug code (NDC) unit or basis for measurement code (code qualifier)
To ensure correct processing, Blue Cross Blue Shield of Michigan requests that the national drug code (NDC) unit or basis for measurement code (code qualifier) reported in Loop 2410 CTP05-1 for source of payment BL be one of the following:
- Report UN (unit) for drugs that come in a vial in powder form that need to be reconstituted before administration
- Report ML (milliliter) for drugs that come in a vial in a liquid form
- Report GR (gram) for topical forms of medicine (e.g., cream, ointment and bulk powder in a jar)
International units should be converted to standard measurements (UN).
Please note use of any other unit or basis for measurement code (code qualifier) in Loop 2410 CTP05-1 could result in a payment modification. For additional information, please refer to the February 2015 Record article or the 837 Professional Health Care Claim Companion Document.
Register for a medical specialty drug prior-authorization web tool refresher course
What's in it for you?
In this course, you'll refresh your skills with the NovoLogix® web tool, and learn how to create prior-authorization requests for provider-administered specialty medical drugs.*
Register for the following Blue Cross Medicare Plus BlueSM PPO webinars:
Once the host approves your registration, you'll receive a confirmation email with instructions for joining the session.
*In July 2017, Blue Cross Medicare Plus Blue PPO launched a prior-authorization program for select provider-administered specialty medical drugs.
October 2018 – Issue
- Blue Cross PPO members who live outside Michigan will need prior authorization for certain services
- We’re simplifying provider appeals process
- Most providers are missing out on medication reconciliation reimbursements. Are you?
- URMBT to participate in medical drug prior authorization program
- New utilization management programs beginning for URMBT members
CHECK OUT THESE ARTICLES AND MUCH MORE HERE!