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Direct Result of the Passing of SB 412 - Open Access to Cancer MedicationThis Law goes into effect June 8, 2022. This means Michigan Managed Medicaid plans cannot require prior authorization for cancer medications. Details >
Live Event November 9, 2022 - Schoolcraft College, LivoniaDetails >Handouts are available and recordings have just been releasedDetails >
June 2022Updates that may be of interest to oncology including:
• Self-Administered Drug Exclusion List Details >Part A, Part B and Part A/B NewsIncludes articles that may be of interest to oncology released in the past 2 weeks
• Also, Medicare Hot Links to 2022 Final Rules and the WPS Fee Schedules Details >• On Demand: Evaluation and Management (E/M) Services Ask-the-Contractor Teleconference (ACT) Recording Available
• NEW YouTube Training: Correct Billing of Not Otherwise Classified (NOC) Codes and MORE! Details >
Recent Oncology Related Articles• Medicare Shared Savings Program: Application Deadlines for January 1 Start Date
• Biosimilars: Interchangeable Products May Increase Patient Access
• Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB)
• Chronic Care Management Services — Revised
• Comprehensive Error Rate Testing Documentation Center Moved on April 13
• Medicare Cards Without Full Names
• Medical Record Maintenance & Access Requirements — Revised
• Recent LearnResource & MedLearn Matters Articles Details >Region 1 - Performant Recovery, Inc.RAC Audits Continue - All related to waste and not using the smallest vial available or not using the JW modifier!
• Double Check To Be Sure You Are Doing It Correctly! Details >This edition includes articles on:• More Audits and More Problems
• A Telehealth Checkup Details >
Recent Oncology Related News• BCN - We’re introducing new program that uses genetic testing to personalize medication treatments
• BCN commercial follows CMS guidelines for use of JW modifier to indicate drug waste
• Duplicate rejections for Medicare Part B supplemental claims
• Important news about submitting medical benefit drug prior authorization requests for Medicare Advantage members
• Register today for the June PGIP quarterly meeting
• DanyelzaTM, Margenza® and SaphneloTM to require prior authorization for URMBT members with Blue Cross non Medicare plans starting June 30
• Inflectra® and Avsola® are the preferred infliximab products for pediatric commercial members starting July 1
• We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members starting August 8
• Additional medical benefit drugs to have site-of-care requirements for BCN commercial members starting Sept. 1 Details >Publications• The Record
• BCN Provider News Details >BCBSM System Still Not Fixed - Keep Sending Us Your Denials!BCBSM is Manually Processing Denials QUICKLY. Details >
Last Reviewed/Updated 6/7/22Review the reported payer reimbursement issues including:
• Resolution - WPS Medicare requirement for infusion monitoring documentation every 15 minutes
• BCBSM issues with Pemfexy, Phesgo, and Denials for Auth Exceeds Allowed Details >Recent Oncology Related NewsMedicaid Updates Include:
• MSA Bulletin Updates - Provider Manual Code Updates
• Biller "B" Aware Notices including a Medicaid Training Webinar on Document Management Portal Refresher Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network News Details >• New clinical edits are going into effect
• Medicaid claims rejection issue resolved
• Medical Policy Update - Infusion Services and Equipment (#91414)
• Site of service restrictions applied for infusion services July 1 Details >Featuring this month: Meridian Health Plan of MIDetails >
Servier's Tibsovo® (ivosidenib)
Novartis' Kymriah® (tisagenlecleucel)
Bristol Myers Squibb's Opdivo® (nivolumab) Details >
Doctor groups say "accumulator" and "maximizer" programs are harming patientsDetails >
June 2022, Frequently Asked Questions• Public Health Emergency Extension
• Billing Drug Waste for New Drug
• Billing for Overfill in a Vial
• Finding Drug Pass Through Status
MSHO MEMBERS - You can access and search previous FAQs! Just use the search field on the bottom right corner of the MSHO website! Details > |
