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Genentech Patient Support Services

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MSHO Featured Corporate Sponsor Assistance Programs

• ADC Advancing Patient Support
• Immunocore's Kimmtrak Connect
• Novartis Patient Assistance Foundation

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WPS Oncology Related LCD Updates

New, retired, and revised policies/articles

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WPS Recent Oncology Related News

• Guidance on Review Issues Related to Ascension's Cyber Incident
• Website Updates
• Expedited Prior Authorization Requests
• Medicare Hot Links
• And More

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WPS Educational Offerings

New training opportunities available

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CMS-Medicare

Recent Oncology Related Articles

• OCM Final Evaluation
• Hospital Price Transparency
• Quarter 4 Edit Files
• MLN Matters
• And More

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MIPS

• How to Participate in MIPS as a Group
• MIPS EUC Policy
• Targeted Review Available Until October 11

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Recent RAC Monitor Article

This edition includes articles on

• Medicare Advantage Plan Sort Of Responds to CMS Complaint
• Little-known Benefits of the Two-Night Rule
• Crushing Drainage Coding Challenges with Complex Case Analysis
• Important Information Concerning Aetna
• Navigators: A Big Healthcare Investment

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BCBSM/BCN

Recent Oncology Related News

• Update to Clinical Editing Billing Tips
• Coming Soon: New Member Site Features
• Paying Brand-Name Drugs That Have Generic Equivalents Available

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 9-16-24

• BCBSM Below Cost Reimbursement
• 0885 Claims Denied
• Procrit  Denials (693)
• Procrit or Epoetin Class Drugs Maintenance
• And More

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Resolved Payer Issues

Last Reviewed/Updated 9-16-24

• BCBSM Carelon Letter

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Aetna

• September 2024 OfficeLink Update

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Cigna

• Policy Updates
• Medical Education & Training
• Coverage Policies

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Health Alliance Plan

• Billing for Medicare Advantage in Hospice Coordination Period
• Reminder - Important Contacts to Help You
• Prior Auth Requirements, Policy Updates, & Pharmacy Info
• Keep Provider Information Updated in NPPES

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Humana

• Pharmacy News 
• Claims Payment Policies
• Claims Coding, Inquiry Process Guidelines 
• Prior Auth & Notification Lists

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Priority Health Update

• DBM Preliminary Payments Were Mailed
• Peer-to-Peer Policy Update
• Updated 2024 HEDIS Provider Reference Guide
• Updated 2024 PIP Manual Now Available
• Rad/Onc Auth. Program With EviCore Launches Sept. 15

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United Healthcare

• Reimbursement Policy Updates
• Medical Policy Updates
• Q4 2024 Preferred Drug List Updates 
• Cancer Support Program 
• And More

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Recent Oncology Related FDA Approvals and Expanded Indications

Novartis Tecentriq Hybreza
Genentech Kisqali (ribociclib)
Merck Keytruda (pembrolizumab)

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ASK MSHO

September 2024 Frequently Asked Questions

• Red Flags When Reviewing Infusion & Injection Claims
• Billing Code 95180 & Chemotherapy
• White Bagging VS Brown Bagging
• IV Hydration With Multiple Drugs

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