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Pfizer's My Healthcare Finance
Pfizer Oncology Together

To learn more about Pfizer's My Health Finances, click here
To learn more about Pfizer Oncology Together, click here

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MSHO Featured Corporate Sponsor Assistance Programs

• Incyte Cares
• Janssen CarePath
• Puma Patient Lynx
• Rigel OneCare

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WPS Oncology Related LCD Updates

• Revised Policies / Articles

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WPS Recent Oncology Related News

• Chronic Care Management Services - CERT Errors
• Disabling Beneficiary Eligibility on the IVR System
• Updated Medicare Hot Links

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WPS Educational Offerings

New training opportunities available

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CMS-Medicare

Recent Oncology Related Articles

• Updated Medicare Enrollment Application
• Changes to Claims Processing for Non-Physician Practitioners
• Program Year 2023 Review and Dispute Reminder
• MLN Matters
• And More

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QPP

• 2024 QPP Exception Applications are Available
• Check Initial 2025 MIPS Eligibility
• Opt-In & Voluntary Reporting Options for 2024
• Upcoming MIPS Important Dates and Deadlines

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MUE

• 2024 Measures Under Consideration List Now Available
• NCCI MUE PTP

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Recent RAC Monitor Article

This edition includes articles on

• Navigating Reclassification from Inpatient to Outpatient Observation
• Coding Challenge: Understanding Underdosing
• New Settlement Highlights Old Fraud: Upcoding

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BCBSM/BCN

Recent Oncology Related News

• Upcoming Medicine Coverage Changes
• MESSA Offering 5-Tier Prescription Drug Plan
• Step Therapy Requirements Added for Some Medicines
• HEDIS Medical Record Reviews Begin in February
• And More

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 12-18-24

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

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Aetna

• Changes Coming to Medical Plan Drug Lists
• December 2024 OfficeLink Update

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Health Alliance Plan

• Multifactor Authentication (MFA) Coming Soon
• HEDIS MY 2024 Medical Record Review Project
• Update - HAP CareSource Marketplace Plans
• Reminder - Benefit Policies, Prior Auth, & Pharmacy Information

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Medicaid

• MMP Bulletins

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Priority Health Update

• New Resources Available for the HMA Product, Launching January 1
• Final 2025 PIP Program Manual & Supporting Resources Available
• The Best Way for Practices to Communicate With us is Through Prism
• Credentialing and Enrollment Status Updates are Available in Prism

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United Healthcare

• Medical Policy Updates
• Reimbursement Policy Updates
• Specialty Medical Injectable Drug Program Updates
• Pharmacy and Clinical Updates

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Recent Oncology Related FDA Approvals and Expanded Indications

AstraZeneca Imfinzi (durvalumab)
Jazz Pharmaceutical Ziihera (zanidatamab-hrii)

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Drug Updates

Geron's RYTELO (imetelstat) Received Permanent J-Code

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ASK MSHO

December 2024 Frequently Asked Questions

• Medical Necessity & Secondary Intent
• Calculating the Time for Hourly Increments of Infusion
• Using Code 36415

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