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MSHO Featured Corporate Sponsor Assistance Programs

• Stemline ARC
• Takeda Oncology Here2Assist
• Blueprint Medicine's YourBlueprint
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WPS Oncology Related LCD Updates

Stay current on new, retired, and revised policies/articles

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WPS Recent Oncology Related News

• Customer Service Training
• Fee Schedules
• Medicare Hot Links

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CMS-Medicare

Recent Oncology Related Articles

• Inflation Reduction Act
• Reduced Coinsurance for Certain Part B Rebatable Drugs
• New Interest Rate for Overpayments & Underpayments 
• Recent Learn Resource & MedLearn Matters Articles
• And more

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Quality

• APM Incentive Payment Extended through 2023
• 2023 MIPS Value Pathways (MVPs) Registration Now Open

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Recent RAC Monitor Article

This edition includes articles on

• The OIG Shines Light on “History of” in MA Programs
• Medicare Advantage Must Follow Two-Midnight Rule
• Preparing for Post-PHE Audits
• Hail the Return of the Three-Midnight Rule

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BCBSM/BCN

Recent Oncology Related News

• Prior Authorization Changes Coming in June
• Prior Authorization Requirements with Non-Michigan Blue Plans
• Upcoming Webinars

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 4/18/23

• BCBSM Withhold on Drugs Related to the PGIP Program
• Meridian Paying for Labs

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Resolved Payer Issues

Last Reviewed/Updated 4/18/23

• BCBSM AIM Auth Limit

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Aetna

• Changes to NPI
• Issue with ID Cards

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Cigna

• Drug and Biologic Coverage Policy
• Denying Modifier 25 Claims
• Updated Informational Documents

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Health Alliance Plan

• Managing Prior Authorizations
• Denials – When To Submit a Corrected Claim vs. an Appeal

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Medicaid

Recent Oncology Related News

Medicaid Updates Include
• MSA Bulletin Updates
• Biller "B" Aware Notices

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Priority Health Update

• New Date Format for Payment Reference IDs
• Clinical Documentation Required for Outpatient Authorizations

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United Healthcare

• Updates for Specialty Medical Injectable Drug Program
• Chemotherapy Observation or Inpatient Hospitalization 
• Medications/Drugs (Outpatient/Part B) 
• And more

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Recent Oncology Related FDA Approvals and Expanded Indications

• Novartis Tafinlar® (dabrafenib) + Mekinist® (trametinib)
• Incyte Zynyz™ (Retifanlimab-Dlwr)
• Astellas & SeaGen PADCEV® (enfortumab vedotin-ejfv) with KEYTRUDA® (pembrolizumab)

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ASK MSHO

April 2023 Frequently Asked Questions

• Observation Codes
• Expiration Dates for PHE

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