Provided by MSHO Managed Care Committee Members:
2019 benefit information delayed for some groups
Due to an issue with loading benefits, detailed benefit information isn't displaying in web-DENIS for some groups. Should you receive an incomplete benefit response, please contact Provider Servicing directly.
We apologize for any inconvenience.
NASCO starting payment recovery for small business groups, including MPSERS, ITS Home
On Dec. 27, 2018, NASCO will begin a payment recovery for small business groups, including MPSERS and ITS Home claims. The recovery will process professional and facility claims that weren't applying cost share correctly.
New user-friendly prompts coming to Pharmacy Prior Authorization Help Desk
As of Dec. 14, 2018, the Pharmacy Prior Authorization Help Desk toll-free number has new, clear and simple call prompts. It will direct you to the proper line of business for eligible Blue Cross Blue Shield of Michigan and Blue Care Network members.
Here's how it works:
Updated clinical practice guidelines now available at MQIC.org
The Michigan Quality Improvement Consortium has released the following updated clinical practice guidelines:
Please visit mqic.org to see the guidelines. To access them on Android and iOS devices, an MQIC app is available at Google Play and the App Store.
Don't issue referrals for BCN Advantage members staying in network
BCN AdvantageSM members don't need a referral to see a specialist within their health plan's network. However, authorizations and plan notifications are still required for certain services. Also, all services with a provider who's not in the member's health plan network require an authorization. More information is available in the Jan-Feb 2019 BCN Provider News.
Updates to our PPO clinical editing appeals process
We're updating our PPO clinical editing appeals process.
What you need to know now:
Look for more information in the January 2019 Record and in the Provider Manual.
Clarification about AllianceRx Walgreens Prime specialty program
The November Record announced that starting Jan. 1, 2019, AllianceRx Walgreens Prime will be the exclusive provider of specialty pharmacy services for some Blue Cross Blue Shield of Michigan commercial, non-Medicare members.
This applies only to specialty drugs filled under pharmacy benefits. We sent letters to affected members telling them to contact you for new prescriptions. AllianceRx Walgreens Prime will call members and help them get their prescriptions moved.
We'll update the current list of specialty drugs in this program monthly.
To find the list at bcbsm.com:
January 2019 – Issue
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