09/15/2025

BCBSM/BCN

Recent Oncology Related News

Blue Cross Blue Shield / Blue Care Network Managed Care Committee Members:

Vernell Hester, COC, CHONC - Downriver Oncology Center

Reminder Regarding the Collection of Applicable Deductibles, Copayments from Members Upfront
Participating providers must bill Blue Cross Blue Shield of Michigan and Blue Care Network for all covered services and may only bill members for their applicable deductibles and copayments. In keeping with provider contracts, you may not collect deposits or bill members upfront for unpaid balances of covered services.

The following guidance comes from the “Patient Copayment and Deductible Requirements” chapter of the Blue Cross Commercial Provider Manual.

• Verify member copayments and deductibles through the provider portal Availity Essentials or Provider Inquiry before collecting them.
• Collect known cost-sharing amounts, such as copayments and unmet deductibles, up to the amount of the member’s liability.
• You may not collect the difference between the Blue Cross approved amount and provider charges, also referred to as balance billing.
• Don’t mandate that patients provide credit card information to secure any future balance. (Patients may voluntarily do so.)

BCN Advantage Update: Office, Outpatient E/M Visit Complexity Add-On Code G2211
In June, Blue Care Network communicated that the Centers for Medicare & Medicaid Services added information on how to use procedure code G2211 with modifier 25 for certain Medicare Part B services starting Jan. 1, 2025, and that their systems were updated to accommodate the changes in May 2025. System updates occurred later than initially communicated, but were completed in June. The affected claims, which were professional claims, will be reprocessed.

To avoid duplicate claim denials and delayed processing, don’t resubmit claims. Please allow up to eight weeks for reprocessing of affected claims.

Starting Oct. 6, Submit Prior Authorization Requests for FEP Members Through the E-Referral System
Starting Oct. 6, 2025, health care providers can submit prior authorization requests for members who have coverage through the Blue Cross and Blue Shield Federal Employee Program through the e-referral system. This change applies to procedures that are managed by Blue Cross Blue Shield of Michigan and affects FEP members who have both commercial and Medicare Supplement plans.

This change will benefit you by:

• Enabling you to submit prior authorization requests for FEP members in the same way you submit requests for other Blue Cross members
• Helping to decrease the time it takes for Blue Cross to process prior authorization requests
• Enabling you to quickly and easily check the status of prior authorization requests through the e-referral system
• Enabling you to communicate with Blue Cross staff through the Case Communication field in the e-referral system

READ MORE 

New Provider Prior Authorizations Website Coming Soon
We are excited to announce the new Provider Prior Authorizations website will launch in the coming weeks. This website will replace ereferrals.bcbsm.com and will offer a more intuitive and user-friendly experience for providers. Information on referrals, prior authorizations and plan notifications will still be found in one place by using this new website. Look for a provider alert with more information on how to reach the new website later in the month.

We sought feedback from office staff who use the current website to help us design a new one that will meet  our needs, including merging information for Blue Cross commercial, Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM into one convenient location. Materials will be organized by topic and specialty for easier navigation.

Key features of the new website will include:

• An updated look and feel, incorporating best design practices and accessibility
• A top navigation menu with quick access by category
• A new search function that searches the entire website
• An expanded footer with instant access to important and frequently used links
• Filters on many pages to help you identify the information you’re looking for

Updated and streamlined content will make it more readable and simpler for you to find what you need. Our goal is to make it easier for you to do business with us, and we're confident this new website will help achieve that goal.

If you have any bookmarked links to pages on the old website, you’ll be automatically redirected to the corresponding page on the Provider Prior Authorizations website, but we encourage you to bookmark the new website pages once the new website becomes available.

When we know the exact date for the new website launch, we’ll publish a provider alert and post a message on the existing ereferrals.bcbsm.com website to let you know when the changeover will occur.

In the future, we'll continue to make improvements to the website, so be sure to check future issues of BCN  Provider News for updates.

Webinars for Physicians, Coders Focus on Documentation, Coding
In 2025, we’ll continue to offer webinars about documentation and coding of common challenging diagnoses. These live, lunchtime educational sessions will also include an opportunity to ask questions.

Below is our schedule and topics for the sessions. All sessions start at noon Eastern time and should last for 30
minutes. Register for the sessions on the provider training website.

Provider training website access
If you have an Availity Essentials™ account, you can access the provider training website this way:

1. Log in to the provider portal at availity.com.
2. Click on Payer Spaces on the menu bar, and then click on the BCBSM and BCN logo.
3. Under Applications, click on the Provider Training Site tile.
4. Click on Submit on the Select an Organization page.

Existing users who used the same email address as their provider portal profile email will be directed to the training site. If you used a different email address, contact ProviderTraining@bcbsm.com to update your profile.

You can also directly access the training through the Provider training website.

After logging in to the provider training website, look in Event Calendar to sign up for your desired session. You can also quickly search for all the sessions with the keyword “lunchtime” and then look under the results for Events. 

You can listen to the previously recorded sessions, too.

Questions?
For more information about the sessions, contact April Boyce at aboyce@bcbsm.com.

For more information about registration or using the provider training website, contact the provider training team at ProviderTraining@bcbsm.com.

For Medical Procedures Managed by BCN Utilization Management, Submit Prior Authorization Requests only for Established Procedure Codes
In the coming months, the Blue Care Network Utilization Management team will no longer process prior
authorization requests for not otherwise classified, or NOC, procedure codes (also known as unlisted codes). This change applies only to medical procedures that are managed by the BCN Utilization Management team for BCN commercial and BCN AdvantageSM members.

We’re making this change because NOC codes often don’t align with procedures that are actually performed. This will help to streamline the prior authorization process for health care providers.

We’ll provide additional information about this change in upcoming provider alerts and newsletter articles, including specific NOC codes for which we’ll no longer process prior authorization requests.

Note: This change doesn’t apply to prior authorization requests for drugs covered under the medical benefit, to
prior authorization requests managed by Blue Cross Behavioral HealthSM or to prior authorization requests that are managed by contracted vendors.

Reminder: How to Check the Status of Prior Authorization Requests to Share With Your Patients
As a reminder, if a patient who has coverage through Blue Cross Blue Shield of Michigan or Blue Care Network asks about the status of a prior authorization request, you can check it for them by following these steps:

1. Log in to our provider portal (availity.com).**
2. Click on Payer Spaces in the menu bar, and then click on the BCBSM and BCN logo.
3. Click on the applicable tile in the Applications tab through which you submitted the authorization request.

Additional information available for providers
Health care providers can also find a summary of services that require prior authorization through our Summary of utilization management programs for Michigan providers document on ereferrals.bcbsm.com.

We’re Helping to Optimize Health Care Delivery and Improve Patient Outcomes
As part of our efforts to optimize health care delivery and improve patient outcomes, Blue Cross Blue Shield of Michigan and Blue Care Network are finding ways to assist members more effectively. This includes identifying high-value care by sharing information related to providers’ delivery of care.

The guidance we’ll share with members, group customers and providers will be determined by claims data, clinical records, quality measures, outcomes data, patient experience metrics and other elements, and may be used to rank, tier and rate health care providers. We may, for example, develop and share information through provider profiles, performance ratings, and cost and quality comparisons — with the goals of promoting high-value care and enabling members and providers to make informed decisions.

In addition, we may use the data we collect to administer incentive programs that recognize and reward performance excellence.

In the coming months, members will have the option to sort search results in our provider directory by performance in their local area. Individual provider-level scores won’t be displayed at this time. Upon launch of this new functionality, members or providers who want more information will be able to click the Learning Library and FAQ link within the Find Care tool and click How do we score providers?

We’re sharing this information so our provider partners are aware of how our efforts in this area may affect them. This initiative aligns with our ability to disclose provider-specific information through our provider participation agreements and with our goal to make care more affordable for our members.

Watch for provider alerts and newsletter articles about specific updates. We’ll also update our provider manuals when appropriate.