Provider Alerts Archive: 2023

December 28, 2023: Changes to ereferrals.bcbsm.com

December 5, 2023: Changes to ereferrals.bcbsm.com

NaviHealth to change its name to Home & Community Care

Updated: Two changes for the services managed by Blue Cross Behavioral Health

Avzivi and Ryzneuta to require prior authorization for most commercial members starting Jan. 1

Casgevy and Lyfgenia to require prior authorization for Medicare Advantage members starting Jan. 2

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

Updated: Don’t submit prior authorization requests to Blue Cross Behavioral Health for dates of service on or after Jan. 1, until further notice

Prior authorization requests for Makena for Federal Employee Program members

Changes to Computed tomography to detect coronary artery calcification questionnaires in the e-referral system on Dec. 17

Additional drugs to require prior authorization for Federal Employee Program non-Medicare members starting April 1

Rystiggo to have a site-of-care requirement for most commercial members starting April 1

Casgevy and Lyfgenia to require prior authorization for most commercial members

We follow CMS guidelines and evidence-based criteria when reviewing inpatient admission requests

Changes to the Medical formula for inborn errors of metabolism questionnaire in the e-referral system

Letters to providers will include reason BCN admissions were bundled

Additional drugs to have site-of-care requirements for some Blue Cross commercial members, starting March 15

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

New labor contract ratified by UAW at Blue Cross Blue Shield of Michigan and Blue Care Network

Updated: Blue Cross continues to pay claims during our union represented employee work stoppage at Blue Cross

Medicare Advantage provider servicing wait times

Updated Requirements for providing behavioral health services to Blue Cross commercial members document will be available in January

Additional drugs to require prior authorization for Federal Employee Program non-Medicare members starting March 1

Step therapy requirement to be added for Soliris and Ultomiris for Medicare Advantage member

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

Update: Additional medical oncology drugs to have requirements for most members

How autism treatment authorizations will continue into 2024

Reminder: Document the need for a continuous glucose monitoring device in the member’s medical record for continued coverage

How to submit clinical information to Carelon when requesting prior authorization

Questionnaires changes in the e-referral system starting Nov. 26

Nov. 23-24 holiday closure: How to submit inpatient authorization requests

Adzynma to require prior authorization for most commercial members

Additional drugs to require prior authorization for Medicare Advantage members starting Feb. 12

e-referral system out of service for maintenance overnight Nov. 18-19

Updated: Entyvio, Omvoh and Wezlana to require prior authorization for most commercial members

November 10, 2023: Changes to ereferrals.bcbsm.com

Update: Kidney-only transplants to require prior authorization through the Human Organ Transplant Program, starting Jan. 1

Solid organ and bone marrow transplants won’t require prior authorization for BCN Advantage members, starting Jan. 1

Changes to prior authorization request process for varicose vein procedures

New and updated questionnaires in e-referral system starting Nov. 5

More information about the Jan. 1 behavioral health changes

Omisirge to require prior authorization for Medicare Advantage members starting Feb. 1

October 24, 2023: Changes to ereferrals.bcbsm.com

October 12, 2023: Changes to ereferrals.bcbsm.com

Cosentyx IV to require prior authorization for most commercial members

Changes to infliximab step therapy requirements for Medicare Advantage members

Updated: For commercial LTACH requests, questionnaire will open in e-referral system

Tecvayli will have additional requirements for most commercial members, starting Dec. 7

Update: Changes to preferred drug designations and prior authorization requirements for Medicare Advantage members

We’ll use updated 2023 InterQual criteria starting Feb. 1

Update: Beyfortus will have limits for commercial members, starting Jan. 1

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

Carelon won’t manage home sleep studies starting Jan. 1

Syfovre and Izervay must not be used with other geographic atrophy drugs for commercial members, starting Nov. 24

Pombiliti, Rivfloza and Tofidence to require prior authorization for most commercial members

Updated questionnaires in the e-referral system starting Oct. 15

Upcoming changes to the TurningPoint provider portal

Vyvgart Hytrulo to have a site-of-care requirement for most commercial members starting Jan. 1

Updated reminder: Changes for in-lab sleep studies to start Oct. 9

Changes to preferred drug designations under the medical benefit for most commercial members, starting Jan. 1

Management of outpatient diabetes supplies for additional members starting Jan. 1

Some diabetes drugs to require prior authorization for Blue Cross and BCN members, starting Jan. 1

Reminder: Facilities must submit appeals within the required time frames

Reminder: Additional services require prior authorization through Carelon

Starting Oct. 1, 2023, we’ll change prior authorization criteria for some weight loss drugs

New and updated questionnaires in the e-referral system starting Sept. 24

Prior authorization no longer required for some procedures, starting Jan. 1

Daxxify to require prior authorization for Medicare Advantage members starting Dec. 18

Update: New and updated TurningPoint medical policies for musculoskeletal and pain management procedures

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

Zynyz to require prior authorization for most members starting Dec. 10

Lumoxiti will no longer require prior authorization starting Sept. 30

Update: Advance notice requirements for noncovered services by independent and hospital labs

Updated Orthoptic and pleoptic visual training questionnaire in e-referral system

Tyruko to require prior authorization for most commercial members starting Sept. 14

Medicare Plus Blue^SM PPO Provider Manual update coming in October 2023

Look for a status note in e-referral system when we pend prior authorization requests for some services

Veopoz, Eylea HD and Daxxify to require prior authorization for most commercial members

Sept. 4 holiday closure: How to submit inpatient authorization requests

Additional drugs to require prior authorization for Medicare Advantage members starting Oct. 15

Prior authorization changes for varicose vein treatments

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

Requirements for prior authorization of Omisirge

Lantidra and Rethymic to require prior authorization for most commercial members

Starting Sept. 1, we’ll require prior authorization for some diabetes drugs

Izervay to require prior authorization for most commercial members

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

Update: Changes for in-lab sleep studies to start Oct. 9

Updated questionnaires in the e-referral system

For commercial LTACH requests, submit information about three SNFs to avoid delays

Rystiggo^® and Vyvgart^® Hytrulo to require prior authorization for most commercial members

Starting Sept. 1, 2023, we’ll change prior authorization requirements for some weight loss drugs

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

Additional drugs to require prior authorization for Medicare Advantage members starting July 10

Elevidys and Roctavian^TM to require prior authorization for most commercial members starting July 6

Submit prior authorization requests for non-emergency air ambulance flights through the Alacura PreAuth Portal

July 3-4 holiday closure: How to submit inpatient authorization requests

Updated Septoplasty and Blepharoplasty questionnaires in the e-referral system

June 19 holiday closure: How to submit inpatient authorization requests

How Blue Cross and BCN are handling authorizations for Makena^® following FDA announcement

Updated Left atrial appendage closure questionnaires in the e-referral system

Reminder: Register for a webinar on June 15 or 21 to learn how to submit requests for ABA services through e-referral

Elfabrio^® and Vyjuvek^™ to require prior authorization for Medicare Advantage members starting Aug. 14

e-referral user guides updated

Carelon to expand existing prior authorization program starting Sept. 1

We’ll use 2023 InterQual^® criteria starting Aug. 1

Vyjuvek™ to require prior authorization for most commercial members

Elahere^TM, Imjudo^®, Tecvayli^TM, Lunsumio^TM to require prior authorization for most members starting Aug. 23

Clarification: Xgeva^® continues to require prior authorization through NovoLogix^® for most commercial members

Elfabrio^® and Omisirge^® to require prior authorization for most commercial members

e-referral system unavailable on three May-June weekends

Qalsody^TM to require prior authorization for Medicare Advantage members starting Aug. 1

Updated questionnaires in the e-referral system, starting May 14

Updated medical record documentation guidelines for musculoskeletal procedures

Register now for training on how to submit LTACH prior authorization requests through the e-referral system

Learn how to submit requests for ABA services through e-referral

Updates to list of musculoskeletal procedure codes that require prior authorization

Qalsody^TM to require prior authorization for most commercial members

Some pre-COVID-19 utilization management requirements to resume July 1

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

Updated Experimental and investigational services questionnaire in the e-referral system starting May 1

Starting June 1, submit prior authorization requests for ABA services through e-referral

Quartet Care Navigation Platform: FAQ for behavioral health providers is available

Updated questionnaires in the e-referral system, starting April 24

Blue Cross and BCN to use Audaire Health^TM provider portal to capture clinical outcomes for CAR-T cell therapy drugs

Changes to maternity support program and new menopause support program

Updated questionnaire in the e-referral system

Tzield^TM to require prior authorization for URMBT members with Blue Cross non-Medicare plans

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

April 7 holiday closure: How to submit inpatient authorization requests

Rolvedon^TM will have requirements for URMBT members with Blue Cross non-Medicare plans

Prior authorization processes for MESSA members changing June 1

AIM to change its name to Carelon

Questionnaire changes in the e-referral system

Lamzede^® to require prior authorization for Medicare Advantage members starting May 1

Jemperli and Opdualag^TM to have site-of-care requirements for BCN commercial members starting July 1

Starting June 1, requests for commercial LTACH admissions and extensions must be submitted through e-referral and not by fax

Briumvi^TM to have a site-of-care requirement for most commercial members starting July 1

e-referral system out of service for maintenance overnight March 18-19

Resources for members coping with the MSU tragedy

Changes to Carelon's (formerly AIM's) provider portal for medical oncology program

Transfer Medicare Advantage members to post-acute care facilities immediately after appeals are approved

Updated: Prior authorization changes coming in June

Starting June 1, submit prior authorization requests for human organ transplants through e-referral and not by fax

Members may call about colorectal cancer screening

Determining prior authorization requirements for patients with non-Michigan Blue plans

Lamzede, Syfovre^™ and Vegzelma^® to require prior authorization for most commercial members

Syfovre^™ to require prior authorization for Medicare Advantage members starting April 3

Behavioral health resources needed for members

e-referral system out of service for maintenance overnight Feb. 18-19

Adstiladrin^® to require prior authorization for Medicare Advantage members starting May 1

Cimerli^TM and Xenpozyme^TM to require prior authorization for URMBT members with Blue Cross non-Medicare plans

Questionnaires available again in the e-referral system

AIM ProviderPortal operating slowly

Transfer Medicare Advantage members to post-acute care facilities immediately after appeals are approved

Rebyota^TM to require prior authorization for Medicare Advantage members starting March 1

Adstiladrin^® and Stimufend^® to require prior authorization for most commercial members starting Feb. 2

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

Briumvi^TM and Leqembi^TM to require prior authorization for most commercial members starting Jan. 26

Byooviz^® is no longer the preferred ranibizumab drug for Medicare Advantage members

Leqembi^™ to require prior authorization for Medicare Advantage members starting Jan. 13

Reminder: Assessments and clinical documentation to submit for services received by Medicare Advantage members in SNFs

Jan. 16 holiday closure: How to submit inpatient authorization requests

Additional drugs to require prior authorization for Medicare Advantage members, starting March 1