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Tecentriq ImagePhesgo ImageGazya Image

To learn more, click on each of the images. For prescribing information, click here for Tecentriq, here for Phesgo, and here for Gazyva. 

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Attention MSHO Members

Support Parity for Oral Cancer Treatments: Please Urge Chairman VanderWall to Hold a Hearing on HB4354

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MSHO Legislative Update: Key Changes for 2022

Wednesday, December 8, 2021 from 12:00 - 1:00 pm

Register TODAY!

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MSHO 12th Annual Payer Update was held on November 10, 2021

Did you miss this valuable meeting?

Handouts are still available. Recordings coming soon!

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WPS Oncology Related LCD Updates

November 2021

Updates that may be of interest to oncology including:
• Multiple MolDx Revised Policies

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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 Proposed Rules, 2021 Final Rules and the WPS Fee Schedules

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Join WPS for a Teleconference, Webinar or Seminar

Check out these upcoming training events:

• Learning Center: Content Library Enhancements
• Teleconference: Prevent Part B Rejections and Denials
• Evaluation and Management Visits in 2022
• On Demand Training Including; Appeals - Understanding the Basics, E & M Services for 2021, 3 Day/1 Day Payment Window, and New YouTube Training on Transitional Care Management and more...

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Recent Oncology Related Articles

• Medicare Billing: 837P & Form CMS-1500
• New/Modifications to the Place of Service (POS) Codes for Telehealth - Effective January 1, 2022
• CMS Releases 2022 Medicare Advantage and Part D Star Ratings to Help Medicare Beneficiaries Compare Plans
• Pneumococcal Conjugate Vaccine, 20 Valent
• Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly
• January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files & Revisions to Prior Quarterly Pricing Files
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Newest approved issues listed on RAC website:
• Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions
• Next Generation Sequencing Medical Necessity and Documentation Requirements

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Recent RAC Monitor Article

This edition includes an article on:

• No Surprises Act Features Some Unpleasant Surprises for Providers

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Recent Oncology Related News

• Blue Cross enhances tools for electronically prescribing medications and submitting prior authorizations
• Register for the December PGIP Quarterly meeting today
• Mark your calendar – 2022 PGIP Quarterly meeting dates
• Nonclinical, transitional care program aims to reduce readmissions for Medicare Advantage members
• Reminder: Optum to provide claim editing for professional and facility claims
• Important Reminder:  BCBSM and BCN are transitioning to a new Pharmacy Benefit Manager
• How to avoid claim rejections when Medicare is primary
• Darzalex FasproTM, PolivyTM and TrodelvyTM require prior authorization for URMBT members with Blue Cross non-Medicare plans, starting Dec. 3
• Prior authorization requirements expanding for Medicare Plus Blue, BCN commercial and BCN AdvantageSM members on Jan. 1
• Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 3
• Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 27

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• The Record
• BCN Provider News
• Blues Brief for Oncology Providers

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Medicare Plus Blue

Monthly Status Report for November

Many updates/corrections. Listed below is a sampling of what you will find:
• 835 Recoupment isn't reflected on voucher
• 835 CARC 210 sanction amount is incorrect
• The system is applying a denied authorization to a claim in error
• Multiple RHC Issues

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Payer Issue Tracking Page

Last Reviewed/Updated 11/16/21

Review the reported payer reimbursement issues including:
• Confusion on the rounding of NDC with BCBSM
• Diagnosis loading for biosimilars to match brand drugs, denied claims reprocessed, Mvasi still pending

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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
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
• UHC Reimbursement Policy Update

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Priority Health Update

• Reminder: THC members newly transferred to Priority Health Choice Medicaid may have benefit changes
• 2022 Commercial Product Updates

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare

Tidbits regarding:
• 1/1/2022 the Reimbursement Policies for UnitedHealthcare Individual Exchange Plans
• Link transition to the new UnitedHealthcare Provider Portal
• UnitedHealthcare is offering training to learn about the new provider portal

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November 2021, Frequently Asked Questions

• Any changes to the infusion section of CPT for 2022?
• Medicare guidelines for an electronic signature
• Medicare Advantage Step Therapy rules for a patient on treatment

MSHO MEMBERS - You can access and search previous FAQs! Scroll to the bottom of the Q & As to find out how!

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