04/16/2019

BCBSM/BCN

Recent Oncology Related News

Provided by MSHO Managed Care Committee Members:

Commercial payer - AARP missing edit in 277CA report

Starting April 1, commercial payer AARP payer ID 36273 may be missing an edit message in the 277CA UNSOLICITED RPT COMMERCIAL O.

If your rejected claim is returned in the 277CA report with no edit message and it is a secondary claim to this payer, please check to see if you included the federal sequestration adjustment amount (CARC 253). This must be included on all electronic Medicare Supplement claims submissions for AARP.

We expect this issue to be corrected on June 4.

We apologize for any inconvenience this may have caused. If you have questions call the EDI help desk at 1-800-542-0945.

Some Blue Cross Blue Shield professional claims were processed twice

Due to a system issue, some Blue Cross Blue Shield professional claims received on March 28, 2019, were sent to the processing system twice.

The second claim should reject as a duplicate. No action is required on your part.

We apologize for any inconvenience.

Re-authorize Blue Cross as your billing agent in new system by May 24

If you don't use Blue Cross web-DENIS or EDI to check Medicaid eligibility, this notification doesn't apply to you.

Starting in May, the routing of Medicaid eligibility transactions between Blue Cross Blue Shield of Michigan and the Michigan Department of Health & Human Services will change. If you currently use Blue Cross to check Medicaid eligibility, you'll need to add us as an authorized billing agent through the MDHHS portal.

To ensure no disruption of your Medicaid eligibility through Blue Cross, before May 24, please:

• Log into the MDHSS portal.
• Click the CHAMPS link.
• Verify Blue Cross is associated as your billing agent for Medicaid eligibility (270/271) — no change is required for claims (837) and remittance (835).
• Use one of the agent codes below:
  • Professional providers, use CHAMPS Billing Agent ID 1200009.
  • Institutional providers, use CHAMPS Billing Agent ID 1200018.
• If Blue Cross isn't listed and you want to continue submitting Medicaid eligibility transactions through us, please associate us as your billing agent using one of the BillingAgent IDs listed above.
• Don't delete your current billing agent.

If your new billing agent information isn't complete before the transition is final, your Medicaid eligibility inquiries may not be accepted at MDHSS.

Got questions?
Refer to the MDHHS Billing Agent website and use the step-by-step instructions on associating a billing agent ID.

If you have questions about completing the Billing Agent form, call Medicaid provider support at 1-800-292-2550 option 4.

If you have general questions about this change, email Blue Cross EDI Customer Management at EDICustMgmt@bcbsm.com.

Thank you for your cooperation as we work through this update.

Medicare Plus Blue^SM PPO claim reimbursements

Effective July 1, 2019, Medicare Plus Blue^SM PPO will implement new reimbursement policies for the following claims billed with Healthcare Common Procedure Coding System or Current Procedural Terminology codes that don’t have an assigned Medicare fee.

General reimbursements (for non-durable medical equipment and non-laboratory claims)

• Medicare Plus Blue PPO will reimburse providers 65 percent of the charged amount for all non-DME and non-lab claims that don’t have an assigned Medicare fee.
• For drug claims, pharmacy pricing resources, if available, will be used before reimbursing at 65 percent of charges. For unlisted surgery codes, reimbursement will be made at the rate of a comparable surgery code.

Note: This payment policy doesn’t apply to procedure codes that currently require an invoice for payment by the Centers for Medicare & Medicaid Services. Also, any CPT codes that are carrier priced will continue to be paid accordingly.

Effective July 1, KhapzoryTM and Fusilev® will be added the prior authorization program for PPO commercial members

Effective July 1, 2019, Khapzory^TM and Fusilev^® will be added to the Medical Drug Prior Authorization Program for Blue Cross Blue Shield of Michigan PPO commercial members. This applies to any members starting therapy on or after July 1.

• Fusilev (levoleucovorin calcium, HCPCS code J0641)
• Khapzory (levoleucovorin sodium, HCPCS code J3490)

These drugs are currently included in the prior authorization program for Blue Care Network HMO^SM commercial members.

The authorization requirement only applies to groups that are currently participating in the commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to BCN Advantage^SM, Blue Cross Medicare Plus Blue^SM PPO or Federal Employee Program^® members.

A prior authorization approval isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members. Members are responsible for the full cost of medications not covered under their medical benefit coverage.

For a list of requirements related to drugs covered under the medical benefit, do the following:

• Visit the Medical Benefit Drugs – Pharmacy page in the Blue Cross section at ereferrals.bcbsm.com.
• Click Requirements for drugs covered under the medical benefit – BCN HMO and Blue Cross PPO under the heading For Blue Cross (commercial) members.

The new prior authorization requirement for Khapzory and Fusilev will be reflected in the requirements list before the July 1 effective date.

Start transitioning adult HMO members using infliximab products to Inflectrata

Starting May 1, 2019, Blue Care Network prefers the infliximab product, Inflectra^® (infliximab-dyyb), for its adult BCN HMO^SM commercial members. This change doesn't apply to:

• BCN Advantage^SM members
• Blue Cross Blue Shield of Michigan PPO commercial members
• Pediatric members 15 years old or younger
• Pediatric members 18 years old or younger, weighing 50 kg or less

Please refer to the current medical policy for all criteria, and begin taking steps to:

• Transition adult members with active authorizations for non-Inflectra infliximab products to Inflectra by May 1, 2019.
• Prescribe or fill Inflectra when possible instead of Remicade^® (infliximab) HCPCS code J1745, or Renflexis^® (infliximab-abda) HCPCS code Q5104.
• Bill Inflectra with HCPCS code Q5103.

Quick links to helpful resources

• Current Medical Policy search tool
• Requirements for drugs covered under the medical benefit

Prior-authorization changes coming to AIM authorization program

Beginning May 1, 2019, the PPO radiology management program, administered by AIM Specialty Health, will be adding a cardiology and in-lab sleep study prior authorization program for Medicare Plus Blue^SM PPO members. AIM is also adding prior authorization procedure codes for its high-tech radiology breast MRI program.

Please note that UAW Retiree Medical Benefits Trust members with Medicare Plus Blue coverage are also included in this program.

For more details please see the February Record article.

Request authorization through AIM's ProviderPortal or call 1-800-728-8008.

April 2019 – Issue

• Blue Cross changing practitioner fees July 1
• Medicare Plus Blue^SM PPO claim reimbursements
• Next Drug Take Back Day scheduled for April 27
• Billing chart: Blues highlight medical, benefit policy changes
  • Including Onpattro, Keytruda, and Alimta
• Enhancements to PPO outpatient claim editing process coming in April
• What to do when error messages display in e-referral
• Know the inpatient admission appeals process for Medicare Plus Blue Utilization Management department
• We’re making updates to Medicare Advantage Physician Office Laboratory List
• Commercial pharmacy audits begin April 2019

CHECK OUT THESE ARTICLES AND MUCH MORE HERE!