Provider Alerts Archive: 2022

Assisted reproductive technology benefit expanded, starting Jan. 1. 2023

Generic pemetrexed to require prior authorization for Medicare Advantage members, starting Jan. 1

BCN to use updated InterQual^® ABA criteria starting March 1

Cognitive rehabilitation questionnaire to be removed from e-referral system on Dec. 18

Questionnaires to be removed from e-referral system on Dec. 18

Rebyota^TM to require prior authorization for most commercial members starting Jan. 5

December-January holiday closures: How to submit inpatient authorization requests

Fylnetra^® and Rolvedon^TM to require prior authorization for most commercial members starting March 13

e-referral system out of service for maintenance overnight Dec. 17-18

AIM won’t require prior authorization for 29 medical oncology drugs for most members starting Jan. 1

Updated fax forms for submitting prior authorization requests to TurningPoint for musculoskeletal procedures

Hemgenix^® and Tzield^TM to require prior authorization for most members starting in December

Issue now resolved: eviCore healthcare^® call center phone and fax lines are currently unavailable

Xenpozyme^TM and Spevigo^® to have site-of-care requirements for most commercial members starting March 1

New and updated questionnaires in the e-referral system starting Nov. 27

Outpatient ECT won’t require prior authorization for BCN members, starting Jan. 1

Nov. 24-25 holiday closure: How to submit inpatient authorization requests

Updated Gastric stimulation questionnaire in the e-referral system

Fylnetra^® to require prior authorization for Medicare Advantage members, starting Dec. 19

e-referral system out of service for maintenance overnight Nov. 19-20

Pemfexy^® to require prior authorization for most members starting Feb. 9

Availity^® Essentials services have been fully restored

How to speed up the review process for AIM prior authorization requests

Nov. 8 holiday closure: How to submit inpatient authorization requests

Prior authorization and billing reminders for SNF interrupted stays for Medicare Advantage members

Updates related to swallow services for BCN

CareCentrix^® home health care: Reference materials and recorded training will be available Oct. 27, 2022

Reimbursement for certified opioid treatment programs to change in 2023

Xenpozyme^TM and Zynteglo^® to require prior authorization for Medicare Advantage members, starting Nov. 1

e-referral system out of service for maintenance overnight Oct. 15-16

Skysona^® to require prior authorization for most commercial members starting Oct. 20

CareCentrix^® home health care: Improved processes for prior authorization requests for Medicare Plus Blue

Avsola^® to require prior authorization for Blue Cross and Blue Shield Federal Employee Program^® non-Medicare members starting Jan. 1

AIM ProviderPortal operating slowly

Update: We’re changing how we manage biologic asthma therapies, starting Jan. 1

Additional medical benefit drugs will require prior authorization for URMBT members with Blue Cross non-Medicare plans starting Jan. 1

Management of medical benefit drugs moving from Accredo^® to Blue Cross for URMBT Blue Cross non-Medicare members

Issue now resolved: AIM ProviderPortal operating slowly

e-referral training tools updated

Spevigo^® to require prior authorization for most commercial members starting Oct. 13

SNF outpatient therapies: How to submit prior authorization requests for BCN members

Xenpozyme^™ to require prior authorization for most commercial members, starting Oct. 6

Spevigo^® to require prior authorization for Medicare Advantage members, starting Sept. 26

e-referral system out of service for maintenance overnight Sept. 17-18

Cimerli^TM to require prior authorization for Medicare Advantage members starting Oct. 3

Update: Updated questionnaires in the e-referral system starting Sept. 11

Zynteglo^® to require prior authorization for most commercial members starting Sept. 22

More Medicare Advantage members to become eligible for Landmark Health’s in-home care program

Opdualag^TM to require prior authorization for most members starting Dec. 1

Skyrizi^® IV to have site-of-care requirement for most commercial members starting Dec. 1

September 5 holiday closure: How to submit inpatient authorization requests

New and updated questionnaires in the e-referral system starting Aug. 28

Cimerli^TM to require prior authorization for most commercial members starting Sept. 1

Availity^® administrators: Set up Health e-Blue^SM tools within Availity

Update: We’re changing how we manage biologic asthma therapies, starting Jan. 1

e-referral system out of service for maintenance overnight Aug. 20-21

Updated Vascular embolization or occlusion (TACE/RFA) questionnaire in the e-referral system

We’re changing how we manage Skyrizi SC and Stelara SC, starting Aug. 15

Some members temporarily not found in AIM ProviderPortal^®

Releuko^® to require prior authorization for most commercial members starting Nov. 1

Alymsys^® to require prior authorization for most commercial members starting Aug. 25

BCN to use InterQual^® ABA criteria for prior authorization requests submitted starting Oct. 1

Due to supply shortages, patients shouldn't be started on Wegovy^®

Three additional medications require prior authorization for Medicare Advantage members, starting Aug. 8

Additional drugs will have requirements for URMBT members with Blue Cross non-Medicare plans

Important information about billing and requesting prior authorization for denosumab

Questionnaire changes in the e-referral system, starting July 25

Starting Aug. 1, radiology code *71271 won’t require prior authorization for Blue Cross commercial members

Amvuttra^™ and Skyrizi^® IV to require prior authorization for most commercial members starting July 28

Starting Jan. 1, requests for commercial inpatient rehabilitation admissions and extensions must be submitted through e-referral and not by fax

We use clinical information to validate providers’ answers to some questionnaires in the e-referral system

e-referral system out of service for maintenance overnight July 16-17

Updated: Questionnaire changes in the e-referral system, starting July 10

Some SecureCare^® clinical performance reports to be available later than expected

Byooviz^® to be the preferred ranibizumab drug for Medicare Advantage members starting Oct. 4

July 4 holiday closure: How to submit inpatient authorization requests

Oxlumo^® to have site-of-care requirement for commercial members starting Oct. 1

Improved process for prior authorization requests for initial SNF stays for Medicare Advantage members

Post-acute care providers need direct access to naviHealth’s provider portal

Availity^® administrators: Set up Health e-Blue^SM tools within Availity

e-referral system out of service on two weekends in June

June 20 holiday closure: How to submit inpatient authorization requests

Updated: Health e-Blue^SM tools: Processing delays for access requests

Reminder: Availity^® administrators must take action now to ensure access to e-referral and Health e-Blue^SM tools within Availity

Updated: Oral surgery questionnaire to open in e-referral system, starting May 29

Cortrophin^® and Ryplazim^® will have requirements for URMBT members with Blue Cross non-Medicare plans

e-referral Type of Care definitions updated

May 30 holiday closure: How to submit inpatient authorization requests

Update: We're removing age limits for autism spectrum disorder services

e-referral system out of service for maintenance overnight May 21-22

Additional medical benefit drugs to have site-of-care requirements for BCN commercial members starting Sept. 1

Fusilev^® will no longer require prior authorization, starting May 31

Fyarro^™ to require prior authorization for most members starting Aug. 16

Fyarro^™ and Tivdak^® will have requirements for URMBT members with Blue Cross non-Medicare plans

Update: Inflectra^® and Avsola^® are the preferred infliximab products for pediatric commercial members starting July 1

Leqvio^® to have site-of-care requirement for commercial members starting Aug. 1

Availity^® administrators: Set up the e-referral tool within Availity

Important news about submitting medical benefit drug prior authorization requests for Medicare Advantage members

AIM to ask for clinical information for Blue Cross commercial radiology and cardiology prior authorization requests

We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members

Update: Time frames for determinations on authorization requests for acute inpatient medical admissions

Availity^® administrators: Ensure access to e-referral and Health e-Blue^SM tools within Availity

CareCentrix^® home health care: HIPPS Questionnaire has been removed for Medicare Plus Blue^SM members who receive services in Michigan

Prior authorization requirements change for radiology code *71271

Updated: questionnaires to open in the e-referral system starting April 24

Availity^® administrators: Set up Health e-Blue^SM tools within Availity

e-referral system out of service for maintenance overnight April 16-17 portal

SecureCare^® to manage outpatient PT, OT, ST, physical medicine and chiropractic services for Blue Cross commercial and Medicare Plus Blue, starting July 5

Medicare Advantage post-acute care: New 7-day limit on documents in naviHealth's nH Access^™ portal

April 15 holiday closure: How to submit inpatient authorization requests

Pilot program with TurningPoint supports members’ musculoskeletal care

Danyelza^™, Margenza^® and Saphnelo^™ to require prior authorization for URMBT members with Blue Cross non-Medicare plans

AIM authorization IDs to include alpha characters starting in April

Availity^® administrators: Set up the e-referral tool within Availity

Carvykti^™ and Byooviz^™ to require prior authorization for commercial members

Blue Cross and BCN information now available within Availity Essentials

TurningPoint coding requirements for musculoskeletal procedures and related services

Update on e-referral news items display

Update: We'll stop accepting faxed requests for commercial SNF admissions starting June 1

Brineura^® won’t require prior authorization for URMBT members with Blue Cross non-Medicare plans

Enjaymo^™ will have prior authorization and site-of-care requirements for commercial members, starting March 17

Behavioral health resources to discuss with your patients

Kimmtrak^® and Tivdak^® to require prior authorization for most members starting May 23

e-referral system out of service for maintenance overnight March 19-20

Carvykti^™ to require prior authorization for Medicare Advantage members starting March 7

Reminder: Starting March 1, we aligned our Local Rules for acute inpatient medical admissions

Empaveli^® and Actemra^® to require prior authorization for Blue Cross URMBT non-Medicare members, starting June 1

We're ending the temporary suspension of clinical review requirements for admission to skilled nursing facilities

Outpatient PT, OT services no longer require prior authorization for Medicare Plus Blue^SM, starting April 1

We're postponing the authorization requirement for *71271 for BCN members

Musculoskeletal procedure authorizations: Reminders for facilities

Submit prior authorization requests for prescription drugs through an ePA tool to avoid processing delays

Enjaymo^™, Vabysmo^™ and Byooviz^® to require prior authorization for Medicare Advantage members

New Mobile cardiac outpatient telemetry questionnaire to open in the e-referral system, starting Feb. 27

CareCentrix HIPPS Questionnaire updates targeted for April for Medicare Plus Blue^SM members who receive home health services in Michigan

Nyvepria^™ and Rybrevant^™ to require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans starting May 16

Leqvio^®, Tezspire^™ and Vabysmo^™ to require prior authorization for commercial members starting in February

e-referral system out of service for maintenance overnight Feb. 19-20

On Feb. 18, the Utilization Management call center at 1-800-392-2512 will be closed until 1 p.m.

e-referral system unavailable overnight Feb. 11-12

TurningPoint authorizations for musculoskeletal surgical and related procedures are valid for six months

Update: Temporary suspension of clinical review requirements continues for admission to skilled nursing facilities from hospitals in certain states

Avsola^® and Inflectra^® will be the preferred infliximab products for commercial members, starting April 1

Vyvgart^™ will have prior authorization and site-of-care requirements for commercial members, starting Jan. 13

Advantages of using the e-referral system for prior authorization requests instead of calling or faxing