01/21/2026

BCBSM/BCN

Publications - Important Articles to Note!

January 2026 Issue Available HERE.

Articles of Interest:

Pharmacy news roundup

New benefits cover telehealth services prior to meeting deductible

We’re enhancing our prospective editing process on Part B Drugs for Medicare Plus Blue PPO

Blue Cross will no longer separately reimburse for procedure code *99459

2026 CPT Category III update: New codes

Billing chart: Blue Cross highlights medical, benefit policy changes

To align with CMS guidelines, Grievance and Appeals will manage the acute inpatient admission appeal process for Medicare Advantage members, starting Dec. 22

2026 FEP Benefit Changes

Reminder: Submit prior authorization requests for FEP^® members through e-referral system

January/February Issue Available HERE.

Articles of Interest:

Page 5      New riders cover telehealth services prior to meeting deductible

Page 7      Blue Care Network fee schedule update reminder

Page 11    Formulary changes affect Medicare Advantage members for 2026

Page 14     Transitions of Care (TRC) HEDIS® measure

Page 15    Medical policy updates

Page 17    We’ll use updated ABA supplemental policy, starting Jan. 1

Page 19    BCN behavioral health fee schedule changes, starting Jan. 1

Page 20    Pharmacy news roundup

Page 22    Use the Medical and Pharmacy Drug PA Portal to submit prior authorization requests for pharmacy benefit drugs

Page 24    Changes to preferred drug designations, other requirements for Medicare Advantage members

Page 32    Fensolvi, Triptodur to require prior authorization, step therapy requirements for most commercial  members, starting Jan. 1

Page 35    We’re changing how we manage Entyvio for most PPO, HMO commercial members, Jan. 1

Page 36    We’re changing how we manage Simponi Aria for most commercial members, starting Feb. 1

Page 43    Reminder: Providers responsible for cost of external second-level peer review cases with upheld decisions