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Sanofi Care Assist

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WPS Oncology Related LCD Updates

August 2022

Numerous retired and revised policies/articles

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Includes articles that may be of interest to oncology released in the past 2 weeks
• Also, Medicare Hot Links to 2022 Final Rules and the WPS Fee Schedules

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CMS-Medicare

Recent Oncology Related Articles

• Medicare Telehealth Services for 2023 – CMS Proposes Substantial Changes
• 2022 APM Incentive Payment Details
• Claims Processing Instructions for the New Hepatitis B Vaccine Code 90759
• HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

While there have been no new updates in over a year, we continue to hear from members who have been audited. Be sure to audit yourself before the RAC audits you!

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Recent RAC Monitor Articles

This edition includes articles on:

• PDPM: Why the Rise in Inaccurate Payments?
• Special Bulletin: CMS Releases IPPS Final Rule

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BCBSM/BCN

Recent Oncology Related News

• We use clinical information to validate providers’ answers to some questionnaires in the e-referral system
• Reminder: Check for authorization requirements; not all Blue Cross patients require AIM authorization
• We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members starting August 8
• Additional medical benefit drugs to have site-of-care requirements for BCN commercial members starting Sept. 1

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Erroneous Reimbursement Denials “Exceeds Auth” When All Are Not Used

BCBSM System Still Not Fixed - Keep Sending Us Your Denials!

BCBSM is Manually Processing Denials.

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Payer Issue Tracking Page

Last Reviewed/Updated 8/2/22

Review the reported payer reimbursement issues including:
• 8/2 Update to BCBSM Phesgo Issue and Denials for Auth Exceeds Allowed

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Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices

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Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network News

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Priority Health Update

• Steps for Faster Claims Resolution
• GuidingCare tips: InterQual SmartSheets and messages
• Legacy THC providers must wrap up claims, appeals by Dec. 31, 2022
• New clinical edits for facility claims going into effect on Sept. 15, 2022

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ASK MSHO

Frequently Asked Questions

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