09/15/2025

BCBSM/BCN

Publications

September 2025 Issue Available HERE.

A Few Articles You Will Want to Check Out: 

• Recent amendment to CNP, PA contracts allows them to participate in certain PGIP incentive programs  
• Blue Cross, BCN are contacting providers about appointment access standards  
• Webinars for physicians, coders focus on documentation, coding  
• Pharmacy news roundup  
• We renamed the tile for the Medical and Pharmacy Drug PA Portal for commercial members  
• Billing chart: Blue Cross highlights medical, benefit policy changes  
• Behavioral Health Incentive Program ending after Dec. 31, 2025  

September/October Bi-Monthly Issue Available HERE.

A Few Articles You Will Want to Check Out:

• New Provider Prior Authorizations website coming soon (Page 2) 
• Return signed contracts for BCN commercial network affiliation or MCG affiliation through DocuSign within 14 calendar days (Page 4) 
• Reminder: Participating providers may only collect applicable deductibles, copayments from members upfront (Page 5) 
• Recorded webinar for providers, office staff focuses on prior authorization best practices (Page 6) 
• Webinars for physicians, coders focus on documentation, coding (Page 7) 
• Be aware of Medicare fraud scheme involving phishing requests by fax and other means (Page 8) 
• Patient Experience: Understanding the importance of the “Getting Needed Care” domain in CG-CAHPS (Page 15) 
• Medical policy updates (Page 16) 
• BCN updates behavioral health fee schedule effective July 1 (Page 17) 
• Pharmacy news roundup (Page 20) 
• Yesintek to have a site-of-care requirement for most commercial members, starting Sept. 1 (Page 21) 
• Submit clinical documentation through Medical and Pharmacy Drug PA Portal (Page 22) 
• Update: Medicare Advantage prior authorization requests submitted through NovoLogix must be submitted through different application (Page 24) 
• Starting Sept. 1, we’ll change how we pay for certain medications for most Blue Cross and BCN commercial members (Page 26) 
• Coding corner: Morbid obesity and its connection to risk adjustments (Page 27) 
• Reminder: Follow these requirements when billing for noncovered services (Page 29) 
• Follow these guidelines when billing for remote patient monitoring (Page 29) 
• CPT II coding (Page 31) 
• Clinical editing updates (Page 32) 
• We’re changing how we manage self-administered hemophilia products for most Blue Cross, BCN commercial members, starting Sept. 1 (Page 37)