like us on facebook connect with us on linkedin connect with us on instagram May 21, 2025

To learn more about Jazz Pharmaceutical’s ZIIHERA, click here.

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MSHO's Navigator Conference - June 9 in Lansing

Register by May 26 for Complimentary Member Pricing!

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MSHO Featured Corporate Sponsor Assistance Programs

• AVYXASSIST™
• IncyteCARES
• ServierONE

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WPS Oncology Related LCD Updates

• Revised Policies / Articles

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WPS Recent Oncology Related News

• CMS CLIA Communications Update
• We Want Your Comments: SRT for the Treatment of NMSC
• Upcoming Events
• Upcoming Closure
• Medicare Hot Links

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WPS Educational Offerings

New training opportunities available

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CMS-Medicare

Recent Oncology Related Articles

• 2025 CAHPS for MIPS Survey
• 2025 QPP Exception Applications Now Available
• Suspension of 8 Improvement Activities for MIPS
• MLN Matters

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Recent RAC Monitor Article

This edition includes articles on

• 340B Savings Must Continue to Drive Local Investment in Healthcare
• Verifying the Authenticity of Federal Contacts
• Why Price Transparency is a Rare Unifying Issue
• Weaponing the OIG
• The Undoing of SDoH Reporting

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BCBSM/BCN

Recent Oncology Related News

• Management of Oncology Medical Benefit Drugs Changes - June 1
• Trazimera Preferred Trastuzumab Product - May 12
• Step Therapy Required for Keytruda & Opdivo for NPC- June 18
• Piasky & Tremfya Have Site-of-Care Requirement - June 1
• Alyglo, Amtagvi, & Loqtorzi Have Requirements - Starting June 1

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Update! Procrit or Epoetin Class Drugs Maintenance
• BCBSM Below Cost Reimbursement

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Resolved Payer Issues

• 0885 Claims Denied With Reason Code 693
• Procrit or Epoetin Class Drugs Maintenance
• Procrit Denials (693)
• 505(b)(2) Oncology Products Being Impacted by Prior Auth

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Aetna

• May 2025 OfficeLink Update
• Drugs Not Covered - And Their Covered Alternatives

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Health Alliance Plan

• Claim Pattern Review Program for Professional Claims
• Plans Offered Through HAP CareSource
• Pharmacy Information
• Preferred Lab Partner
• And More

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Molina

Recent Oncology Related News

• Preferred Drug List

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Medicaid

• Update to Supervising Claim Voids
• Record Keeping Reminder
• MMP Bulletin

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Priority Health Update

• Digestive Health Support Platform Available June 1
• Food Delivery Services Covered for Some Members Starting June 1
• Commercial & Medicaid Formulary Changes Taking Effect
• May 2025 Billing Policy Updates
• And More

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United Healthcare

• Medical Policy Updates
• Reimbursement Policy Updates
• Pharmacy and Clinical Updates
• Advance Notification and Prior Authorization Requirements
• And More

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Recent Oncology Related FDA Approvals and Expanded Indications

Incyte Zynyz® (retifanlimab-dlwr)
Abbvie Emrelis™ (telisotuzumab vedotin-tllv)
Merck Welireg® (belzutifan)

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ASK MSHO

May 2025 Frequently Asked Questions

• 96376 Reported in Conjunction With 96374 or 96375
• Oral Hydration VS Intravenous Hydration Therapy

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