like us on facebook connect with us on linkedin follow us on twitter August 24, 2022

 

Rigel 2

To learn more about Rigel's Tavalisse Patient Assistance Programs, CLICK HERE.

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MSHO is Looking for a Volunteer

BCBSM Managed Care Committee Member

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Save The Date - MSHO 13th Annual Payer Update!

Live Event November 9, 2022 - Schoolcraft College, Livonia

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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

• 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.

Be sure to audit yourself before the RAC audits you!

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Recent RAC Monitor Articles

This edition includes articles on:

• Future of Medicare Telehealth: 122 Years of Innovation
• Post-COVID Medicare and Medicaid: Rules Matter

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BCBSM/BCN

Recent Oncology Related News

• Alymsys® to require prior authorization for most commercial members starting Aug. 25
• Releuko® to require prior authorization for most commercial members starting Nov. 1
• Additional fee change schedules added to our provider portal as of 08-12-2022:
• Reminder: Check for authorization requirements; not all Blue Cross patients require AIM authorization
• 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 MSHO Your Denials!

BCBSM is Manually Processing Denials.

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Payer Issue Tracking Page

Last Reviewed/Updated 8/24/22

Review the reported payer reimbursement issues including:
• 8/12 Resolution 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

• Prior authorization is now required for IMRT services
• New clinical edit: Principal or first-listed diagnosis codes
• 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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Recent Oncology Related FDA Approvals and Expanded Indications

· Daiichi Sankyo & AstraZeneca ENHERTU® (fam-trastuzumab deruxtecan-nxki)
· Bayer Nubeqa (darolutamide) + Docetaxel

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PBM Specialty Pharmacy Requirement Hurting Patients, Specialists Say

Hassles with prior authorization, delivery make it harder to dispense needed medications

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Surprise Billing Regulations Finalize Insurer-Doctor Dispute Process

Final rule is "a little more provider friendly," doesn't default to median in-network rates

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ASK MSHO

Frequently Asked Questions

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