Provider Alerts

Most Blue Cross and BCN commercial members must obtain continuous glucose monitor products through an exclusive provider starting Jan. 1

Save time when requesting prior authorization for medical benefit drugs for Blue Cross and BCN commercial members

Changes to preferred drug designations for Medicare Advantage members starting Jan. 1

Starting Jan. 1, 2027, there'll be changes to how certain medications are covered on the Premium Drug List

Additional drugs to require prior authorization for most members through the Oncology Value Management program starting Jan. 1

Update: Enoby and Xtrenbo will be the preferred denosumab biosimilar products for Medicare Advantage members starting Oct. 1

Starting Jan. 1, 2027, we’ll change how we cover certain drugs on our drug lists

Use established HCPCS and CPT codes when submitting prior authorization requests for BCN members

Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Sept. 27

Update: Oncology gene and cell therapy drugs to be managed through the Oncology Value Management program starting Jan. 1

Isembyld IV and Fayuvi IV to require prior authorization for most members starting Sept. 28 and Oct. 1

Guidelines for submitting clinical information for medical necessity review of inpatient medical or surgical admissions

We're making changes to preferred drug designations under medical benefits for most members, starting Jan. 1

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

Updated TurningPoint medical policies for musculoskeletal and pain management procedures

Update admission and discharge dates on authorizations for Medicare Advantage SNF, LTACH and IRF stays before submitting claims

HelpScript enrollment service for manufacturer copay assistance will include Blue Cross, BCN commercial members who receive treatments from facility providers

Zanvastro IV to require prior authorization for most members starting Sept. 21 and Oct. 1

MESSA members will have requirements under the Oncology Value Management program starting Jan. 1

Referrals to home healthcare for Medicare Advantage members: Grace period extended through Dec. 31 for acute care providers

Update: Some BCN members displaying as inactive in error

Retracted: Enoby and Xtrenbo will be the preferred denosumab biosimilar products for Medicare Advantage members starting Oct. 1

Enoby and Xtrenbo will be the preferred denosumab biosimilar products for most commercial members starting Jan. 1

Sept. 7 holiday closure: How to submit authorization requests for inpatient admissions

Ponlimsi to require prior authorization for Medicare Advantage members starting Oct. 1

Genglycos IV and Pasatru IV to require prior authorization for most members starting Aug. 31 and Oct. 1

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

Tudriqev to require prior authorization for most members starting Aug. 24 and Sept. 1

e-referral system out of service for maintenance August 22-23

Submit additional clinical documentation to support LTACH payment methodology for Medicare Advantage members

How we communicate changes to questionnaires that open in the e-referral system

Additional medical benefit drugs to require prior authorization for Blue Cross commercial URMBT members starting Nov. 4

Issue Resolved: Requesting authorization if e-referral system shows an incorrect message about global referrals for BCN commercial members

Save time when requesting prior authorization for non-coronary vascular stent procedures

New e-referral message will help you save time with some outpatient authorization requests for BCN members

Change to breast reduction questionnaire for BCN commercial starting July 26

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

e-referral system out of service for maintenance July 18-19

Blenrep to require prior authorization for Blue Cross commercial URMBT members starting Oct. 7

Tregzi to require prior authorization for most members starting July 13 and Aug. 3

Lumvoa IV to require prior authorization for most members starting July 13 and Aug. 3

Starting July 1, your patients may be eligible for GLP-1 weight loss coverage through Medicare GLP-1 Bridge

Respond to calls and inquiries from HelpScript