Providers

An outline of the new clinical edits for professional and facility claims.

As you may know, in April 2022, Governor Whitmer signed the prior authorization reform bill, Public Act 60 (PA 60), into law. We’re excited that this legislation supports streamlining how we work with each other, making it easier for our members – your patients – to get the care they need when they need it.

Changes to our National Precertification List (NPL) applying to both our commercial and Medicare members.

We have received multiple questions regarding the impact the Blue Cross Personalized Medicine℠ program has on your annual Product Exhibits. As a reminder, this is the program that uses genetic testing to personalize medication treatments.

Welcome to the Department of Veterans Affairs Community Care Network (VA CCN). You are invited to attend a Veterans Affairs Community Care Network Overview educational session. Join us for one of the following virtual one hour educational presentations to learn more about VA CCN, treating Veterans and doing business with VA and Optum.

Now that claim reconsiderations and appeals must be submitted electronically, we want to help make sure you have the how-to information you need to manage them with ease.

Corewell Health South's Compliance team's presentation to the LMOA membership.

Blue Care Network Qualification Form must be submitted online within the BCN Health e-Blue℠ application.

We’re reissuing new ID cards to our commercial members to update the pharmacy processing information on the back of their card. This change will take effect April 1. Members will receive their new cards between March 31 and April 28.

We’ve partnered with Livongo to offer a digital diabetes management program to your commercial fully funded patients with type 2 diabetes. This program will strengthen the care you provide and offer the extra support your patients need to manage their health.

The latest monthly update from United Healthcare

Recently fixed errors for certain services

Blue Care Network mailed additional letters at the beginning of March 2023, to primary care physicians and prescribers with BCN patients who are being offered the opportunity to receive a pharmacogenomics test as part of BCN’s new Blue Cross Personalized Medicine℠ program.

Informational handouts from Humana

Informational handouts from Humana

As of Mar. 1, 2023, providers now have 60 days post authorization denial to file a level I appeal. If that appeal is denied, they’ll have 30 days post level I appeal denial to submit a level II appeal.

A patient’s decision about their care can be a big, life-changing decision. 2nd.MD through Accolade is a leader in virtual medical decision-making, connecting people facing high-impact medical scenarios with top specialists through video consultations, to help them make informed health care decisions.

The February tragedy at Michigan State University has had a significant impact on our members and your patients. Your physicians likely have patients who could benefit from behavioral health or care management services.

The Lakeland Medical Office Association invites you to attend our March luncheon and seminar.

Blue Cross Blue Shield of Michigan and Blue Care Network have contracted with Covera Health to launch a radiology-focused quality improvement program to help us better support radiologists and referring providers in their efforts to improve diagnostic quality, overall care and patient outcomes.