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Merck Access Program - Keytruda

For more information, CLICK HERE.

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Save The Date - MSHO 13th Annual Payer Update!

Live Event November 9, 2022 - Schoolcraft College, Livonia

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WPS Oncology Related LCD Updates

June 2022

Updates that may be of interest to oncology including:
• Self-Administered Drug Exclusion List

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Includes 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

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Join WPS for a Teleconference, Webinar or Seminar

• YouTube Training:  Correct Billing of Not Otherwise Classified (NOC) Codes and MORE!

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Recent Oncology Related Articles

• July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• ICD-10-CM Diagnosis Codes: Fiscal Year 2023
• Medicare Shared Savings Program: Application Deadlines for January 1 Start Date 
• Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB)
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

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.

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Recent RAC Monitor Articles

This edition includes articles on:

• The Challenges of Billing Observation Correctly
• Supreme Court’s 340B Ruling Resonates Throughout Healthcare Industry

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Recent Oncology Related News

• Provider Secured Services, including web-DENIS, end date extended for some functions
• BCN AdvantageSM to review reimbursement of claims
• Benefits and out-of-pocket costs for Collaborative Care members from another Blue plan
• 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
• Important news about submitting medical benefit drug prior authorization requests for Medicare Advantage members
• 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

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• The Record
• BCN Provider News

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Erroneous Reimbursement Denials “Exceeds Auth” When All Are Not Used

BCBSM System Still Not Fixed - Keep Sending Us Your Denials!

BCBSM is Manually Processing Denials QUICKLY.

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Payer Issue Tracking Page

Last Reviewed/Updated 6/22/22

Review the reported payer reimbursement issues including:
• BCBSM Pemfexy issue resolved, Phesgo, and Denials for Auth Exceeds Allowed still pending

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Physicians Health Plan (PHP) Update

Zellis ePayments Postponed to July 26, 2022 and New Mailing Address Reminder

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Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates - Provider Manual Code Updates
• Biller "B" Aware Notices including a Medicaid Training Webinar on Document Management Portal Refresher

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Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• Humana YourPractice
• UHC Network News

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Priority Health Update

• Online peer-to-peer requests, 2022 InterQual criteria coming to GuidingCare
• 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

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Meridian Health Plan of MI

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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.

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