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Fall Payer Update

November 13 - Livonia, MI

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MSHO Featured Corporate Sponsor Assistance Programs

• Astellas Pharma Support Solutions
• MyNavCare Patient Support By Genmab
• Lilly Oncology Support Center 

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WPS Oncology Related LCD Updates

• Revised Policies / Articles
• Proposed LCDs Are Open For Comment
• Proposed LCD Open Meeting

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WPS Recent Oncology Related News

• Enroll in EFT to Get Paid for CHAMPVA Claims
• G2211 Add-on Complexity
• Updated 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

• Medicare Two Dollar Drug List Model
• Cost Savings for 54 Prescription Drugs
• Clinical Laboratory Fee Schedule
• MLN Matters
• And More

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MIPS & QPP

• New Links on the eCQI Resource Center
• 2024 MVPs Registration Open
• 2025 Virtual Group Election Period Now Open
• 2024 Qualifying APM Participant (QP) Status

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Quality

• Advanced APM Incentive Payment
• New APM and APP Resources

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Recent RAC Monitor Article

This edition includes articles on

• Don’t use the Neoplasm Table with NETs
• 340 B Drugs: Rebates Versus Discounts
• MDRP Final Rule Unveiled
• Discharge Summaries Make a Difference

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BCBSM/BCN

Recent Oncology Related News

• Provider Portal Feature to Enhance Prior Auth Process
• Guidelines for Billing Split or Shared Visits
• Oncology Medical Drug Management Moving to OncoHealth

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 10-15-24

• 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 10-15-24

• BCBSM Carelon Letter

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Aetna

• October 2024 OfficeLink Update

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Health Alliance Plan

• Prior Auth Requirements, Benefit Coverage Updates, & Pharmacy Infor
• Medicare Complete Duals Annual Required Training
• Keep Provider Information Updated in NPPES

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Medicaid

• MMP Bulletin

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Priority Health Update

• Oct. 29 2025 DBM Program
• Drug Take Back Day Oct. 26
• Understanding Why a Claim is Denied
• Exclusion Criteria Added to SUPD Provider Tipsheet
• And More

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United Healthcare

• Reimbursement Policy Updates
• Medical Policy Updates
• PharmacyUpdate 
• Clinical Program Drug Strp Therapy 
• And More

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Recent Oncology Related FDA Approvals and Expanded Indications

Johnson & Johnson Rybrevant (amivantamab-vmjw)
Sanofi Sarclisa (isatuximab)
AstraZeneca Tagrisso (osimertinib)
Pfizer Hympavzi (marstacimab-hncq)

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Drug Updates

• BeiGene's TEVIMBRA® (tislelizumab-jsgr) Injection Receives J-code & WAC
• NTAP Available for Johnson & Johnson's TALVEY® (talquetamab-tgvs)
• Results of Aveo's Phase 3 TiNivo-2 Study

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ASK MSHO

October 2024 Frequently Asked Questions

• Codes 96372 & 96373
• ASP Pricing Files
• HCPCS Code or Drug Not Found on ASP Pricing Files
• Recently Approved Generic Drug

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