Provider Alerts Archive: 2024

Cosentyx IV to have an additional step therapy requirement for most commercial members starting Feb. 12

Generic pemetrexed to require prior authorization for most members starting Jan. 1

Steqeyma to require prior authorization for most members

Online behavioral health care navigation solution to end March 2025

Enzyme replacement therapy drugs to have a quantity limit requirement for most commercial members

Questionnaire updates in the e-referral system effective Dec. 22

December – January holiday closure: How to submit authorization requests for inpatient admissions

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

Starting Feb. 1, 2025, Cimzia will change to nonpreferred on our prescription drug plans

Elrexfio, Eylea HD and Vyvgart Hytrulo to have requirements for Blue Cross commercial URMBT members starting March 13

Beqvez and Kebilidi will have additional requirements for most commercial members starting Jan. 27

Share Your Feedback on the New Provider Prior Authorizations Website Before Launch - Sneak Peek Available Until Dec. 16

Until Dec. 22, fax requests for prospective inpatient admissions with procedure code *99222

Update: Providers can upload medical records through Availity Essentials for additional types of requests, starting Dec. 16

Yesintek to require prior authorization for most members

Omvoh IV and SC to have an additional step therapy requirement for most commercial members starting Jan. 17

More information about the Oncology Value Management program through OncoHealth

Questionnaires removed from the e-referral system on Nov. 24

Bkemv, Niktimvo and Pyzchiva will require prior authorization for Medicare Advantage members starting Feb. 3

Nov. 28-29 holiday closure: How to submit authorization requests for inpatient admissions

Kebilidi to require prior authorization for most members

Aucatzyl IV to require prior authorization for most members starting Nov. 21

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

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

Guidance and instructions for completing NOMNC and DENC forms for post-acute care stays for Medicare Advantage members

Register for a Nov. 22 session about changes to post-acute care services for Medicare Advantage members

Step therapy requirements added for Soliris, Ultomiris and Simponi Aria for Medicare Advantage members starting Feb. 3

Nov. 5 holiday closure: How to submit authorization requests for inpatient admissions

Hympavzi and Imuldosa to have a prior authorization requirement for most members

BAHA (Bone-anchored hearing aid) questionnaire removed from the e-referral system

We changed how we manage immunoglobulin therapies for most commercial members starting Oct. 1

Prior authorization approvals now valid for 180 days for PTs and OTs in Category A

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

You can now add comments when answering InterQual Connect questions in the e-referral system

Tremfya IV will require prior authorization for Medicare Advantage members starting Dec. 2

Otulfi to have a prior authorization requirement for most members

Register now for Oct. 10 webinar on prior authorization programs with Carelon

Select a recommended procedure when answering InterQual Connect questions in the e-referral system

Updated forms now available for submitting prior authorization requests for post-acute care services

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

Changes to the Breast Elastography Trigger questionnaire in the e-referral system

Facilities can now enter post-acute care prior authorization requests for Medicare Advantage members in e-referral

Issue resolved: Don’t add comments when answering InterQual Connect questions in the e-referral system

2025 coverage change for GLP-1 drugs to treat obesity

Preferred product for Hemgenix for most commercial members starting Nov. 11

Beqvez to require prior authorization for Federal Employee Program non-Medicare members starting Jan. 1

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

Medical benefit oncology drugs that will require prior authorization through OncoHealth starting Jan. 1

Elrexfio, Lunsumio, Talvey and Tecvayli will have additional requirements for most commercial members

Ocrevus Zunovo SC to have requirements for most commercial members starting Oct. 3

Update: Tremfya IV to require prior authorization for most commercial members starting Sept. 26

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

Jubbonti and Wezlana to require prior authorization for Medicare Advantage members starting Nov. 3

Rituximab preferred agents to change for Medicare Advantage members starting Jan. 1

Additional musculoskeletal spinal procedures to require prior authorization for Blue Cross commercial members starting Nov. 27

Update: Learn more about changes related to post-acute care services for Medicare Advantage members starting Oct. 1

Pavblu to require prior authorization for most commercial members starting Sept. 5

Sept. 2 holiday closure: How to submit authorization requests for inpatient admissions

Update: Prior authorization changes for blepharoplasty, enteral nutrition, percutaneous left atrial appendage and varicose vein treatment starting Sept. 8

Niktimvo IV to require prior authorization for most commercial members starting Sept. 5

Zynyz and Talvey to require prior authorization for URMBT members with Blue Cross non-Medicare plans

Enzeevu to require prior authorization for most commercial members starting Aug. 29

PiaSky and Tecelra will require prior authorization for Medicare Advantage members starting Oct. 1

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

Physician appointment access survey in process

Tecelra to require prior authorization for most commercial members starting Aug. 15

Preferred immune globulin products for Medicare Advantage members to change starting Nov. 1

Rytelo to require prior authorization for most commercial members starting Aug. 8

Update: Changes coming for select weight loss drugs for some commercial members

Blue Cross Behavioral Health no longer requires autism diagnostic re-evaluations

Guidelines for billing Avastin for Blue Cross and BCN commercial members

Epysqli to require prior authorization for most commercial members starting Aug. 8

Changes to the BCN referral and authorization requirements for Michigan providers document

Tyenne, Tofidence and Zinplava to have a site-of-care requirement for most commercial members starting Nov. 1

Rytelo will require prior authorization for Medicare Advantage members starting Aug. 1

Updated TurningPoint medical policies for musculoskeletal and pain management procedures

Release schedule for eviCore category assignments and practitioner performance summaries for PTs and OTs

Kisunla and Ohtuvayre will require prior authorization for Medicare Advantage members starting July 15

Kisunla to require prior authorization for most commercial members starting July 18

e-referral system unavailable on two weekends in July

Ahzantive, Nypozi and Pyzchiva to require prior authorization for most commercial members starting July 18

Home health care services won’t require prior authorization for Medicare Advantage members starting Oct. 1

We’re changing how we manage immunoglobulin therapies for most commercial members starting Oct. 1

Yimmugo and Piasky to require prior authorization for most commercial members starting July 11

July 4-5 holiday closure: How to submit authorization requests for inpatient admissions

Utilization management phone closed on June 28 until 1 p.m.

Questionnaire changes in the e-referral system starting June 23

Step therapy requirements added for Soliris and Ultomiris for Medicare Advantage members with PNH starting Sept. 16

Lamzede and Vyjuvek to have requirements for URMBT members with Blue Cross non-Medicare plans

June 19 holiday closure: How to submit authorization requests for inpatient admissions

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

Reminder: Bill HCPCS code J3590 for off-label intravitreal use of Avastin for Blue Cross commercial members

Beqvez will have additional requirements for most commercial members

Vyjuvek will have additional requirements for most commercial members starting July 22

Bkemv to require prior authorization for most commercial members starting June 13

Alyglo has requirements for Federal Employee Program non-Medicare members as of June 1

Update: Changes coming for select weight loss drugs for some commercial members

Soliris and Ultomiris to have a step therapy requirement for commercial members

Opuviz and Yesafili to require prior authorization for most commercial members starting June 6

Medicare implantable ambulatory event monitors questionnaire removed from the e-referral system

Hemlibra to have a quantity limit requirement for most commercial members

Changes to the Hyperbaric oxygen therapy questionnaires in the e-referral system

Step therapy requirement added for Saphnelo for Medicare Advantage members starting Sept. 1

May 27 holiday closure: How to submit authorization requests for inpatient admissions

Tricia A. Keith to succeed Daniel J. Loepp as president and CEO of Blue Cross Blue Shield of Michigan

New information about Winrevair SC for commercial members

We’ll use 2024 InterQual criteria starting Aug. 1

Changes coming to prior authorization process for postacute care services for Medicare Advantage members

Loqtorzi to have requirements for most members starting Aug. 15

Spevigo SC and Tyenne will require prior authorization for Medicare Advantage members starting July 1

Beqvez will require prior authorization for Medicare Advantage members starting June 1

Syfovre, Izervay and Elfabrio to have requirements for URMBT members with Blue Cross non-Medicare plans

Update: Prior authorization no longer required for autism-related PT, OT, ST and physical medicine services for BCN commercial members

e-referral system unavailable on two weekends in May

Step therapy requirement added for botulinum toxins for Medicare Advantage members starting Aug. 5

Update: Beqvez to require prior authorization for most commercial members starting May 9

Pemfexy and Pemrydi RTU to have additional step therapy requirements for most members

Changes to the Facial feminization surgery and chondrolaryngoplasty questionnaire in the e-referral system

Hercessi to require prior authorization for most commercial members starting May 16

Save time: Submit only required information about inpatient acute care medical / surgical admissions

Additional drugs to have a site-of-care requirement for some commercial members, starting Aug. 1

Guidelines for using the Autism diagnostic evaluation results form

Change to prior authorization process for Blue Cross commercial members in Michigan whose plans have local provider networks

TurningPoint opens peer-to-peer reviews to advanced practice providers for musculoskeletal and pain management procedures

Omvoh SC and IV to have a step therapy requirement for most commercial members starting June 3

Update: Spevigo SC to have requirements for most commercial members starting April 25

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

Amtagvi will have additional requirements for most commercial members, starting May 28

Procedure codes that require prior authorization through BCN

Cosentyx IV to have a site-of-care requirement for most commercial members starting July 1

Update: Winrevair to require prior authorization for Medicare Advantage members starting May 1

Vyjuvek to have a site-of-care requirement for most commercial members starting April 4

Questionnaire changes in the e-referral system starting March 31

Cinryze, Elfabrio and Evkeeza to have a site-of-care requirement for most commercial members starting July 1

Columvi, Daxxify and Qalsody to require prior authorization for URMBT members with Blue Cross non-Medicare plans

March 29 holiday closure: How to submit authorization requests for inpatient admissions

Lenmeldy to require prior authorization for most commercial members starting March 28

Step therapy requirement to be added for VPRIV and Elelyso for Medicare Advantage members starting June 1

Tofidence will require prior authorization for Medicare Advantage members starting May 1

Elrexfio and Talvey to require prior authorization for most members starting June 20

Explanation of lifestyle modification for weight loss drugs

Wyost SC, Jubbonti SC and Tyenne IV and SC to require prior authorization for most commercial members starting March 21

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

Update: Preferred product for Zynteglo for most commercial members starting April 19

Udenyca Onbody to require prior authorization for most commercial members effective immediately

Update: Prior authorization requirements are changing for musculoskeletal pain management and spinal procedure codes

We’re changing how we manage Entyvio SC and Omvoh SC, starting March 1

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

Medicare Plus Blue PPO Provider Manual update coming in April 2024

Update: Prior authorization requests for behavioral health services

Changes to the Gastric stimulation and Breast reconstruction questionnaires in the e-referral system

Update: Amtagvi to require prior authorization for most commercial members starting Feb. 29

Additional preferred products for Soliris and Ultomiris for most commercial members starting April 1

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

Don’t submit referrals for members with BCN point-of-service plans

Additional cardiology services to require prior authorization through Carelon for commercial members, starting May 11

Call Blue Cross Behavioral Health if you need additional ABA units to bill approved authorizations

Starting in March, we’ll no longer attach approval letters to Blue Cross commercial inpatient authorizations

We’re no longer mailing some letters related to Medicare Advantage inpatient admissions

Pemfexy to have step therapy requirements starting April 26

Omvoh to have a site-of-care requirement for most commercial members starting May 1

Include complete clinical information when submitting prior authorization requests for weight loss drugs

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

Questionnaire changes in e-referral starting Jan. 28

In the Blue Cross Behavioral Health provider portal, complete only the required fields when searching for a member

Starting March 1, some continuous glucose monitor products will require prior authorization

Updated: Alyglo to require prior authorization for most commercial members starting Jan. 18

Cabenuva to have requirements for most commercial members starting May 1

Email us if you’re having technical problems using the Blue Cross Behavioral Health provider portal

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

Continuity of care arrangements are expanded to Medicare Advantage members

Requirements changing for some medical benefit drugs for Medicare Advantage members

Blue Cross Behavioral Health to reinstate requirements; providers can submit authorization requests

January 2, 2024: Changes to ereferrals.bcbsm.com

Jan. 15 holiday closure: How to submit authorization requests for inpatient admissions