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06/17/2025

BCBSM/BCN

Recent Oncology Related News

BCBSMBCN


Blue Cross Blue Shield / Blue Care Network Managed Care Committee Members:

Vernell Hester
Vernell Hester, COC, CHONC - Downriver Oncology Center

Update to BCBSM Retacrit and Procrit Maintenance Dose Billing Issues
On June 17, MSHO spoke with BCBSM regarding the ongoing issue we are having with inappropriate denials of claims and inappropriate reimbursement on our Medicare Plue Blue Claims for Retacrit and Procrit. 

Effective immediately, please compile a spreadsheet with the claim information; denial codes; and amount reimbursed, if anything, and send it to MSHO's Reimbursement Consultant, Deborah McNeilance, at billing@msho.org. *It would be helpful if you could name the file your practice name and date so I can keep track of these in an organized manner. 

Most of the claims that are impacted are due to a system error during the adjudication process.  Unfortunately, at this time, there is no permanent solution and these claims must be manually processed.  

Please refrain from contacting BCBSM directly.  There are too many of you and that will only cause further delay in processing these claims. 

Thank you for your cooperation while we work with BCBSM on this issue. 

See additional updates on our Payer Tracking Page.

Fees for New Telemedicine E/M Procedure Codes to Start July 1
Blue Cross Blue Shield of Michigan and Blue Care Network will change practitioner fees for certain services provided on or after July 1, 2025. These changes may affect all health care providers — including behavioral health providers — for evaluation and management services provided through synchronous audio-video visits.

Commercial members
For Blue Cross and BCN commercial members, the Blue Cross and BCN fee schedules are the primary source of information about fees. To find the fee schedules:

  1. Log in to our provider portal at availity.com.**
  2. Click on Payer Spaces on the menu bar, and then click on the BCBSM and BCN logo.
  3. Scroll down, and then click on Secure Provider Resources (Blue Cross and BCN).
  4. Click on the Fee Schedule drop-down menu, and then click on one of the following:

Medicare Advantage members
For Medicare Plus Blue℠ and BCN Advantage℠ members, follow the guidance from the Centers for Medicare & Medicaid Services when billing for telemedicine E/M services.

Starting Aug. 1, 2025, We’ll Change How We Cover Revlimid
Blue Cross Blue Shield of Michigan and Blue Care Network will change how we cover Revlimid® on the drug lists associated with our prescription drug plans, starting Aug. 1, 2025. This change will affect most Blue Cross and BCN commercial members under the pharmacy benefit.

Brand name Revlimid will no longer be covered for members starting Aug. 1, Instead, we’ll cover the generic equivalent, lenalidomide. If members continue to stay on Revlimid, they’ll be responsible for the full cost. Members can talk to their doctor if they have concerns about this change.

If the member’s pharmacy is unable to fill their prescription with generic lenalidomide, Walgreens Specialty Pharmacy can fill their prescription. Members can call the Walgreens Specialty Pharmacy team at 1-866-515-1355 with questions.

We’ll notify affected members of these changes and encourage them to talk with you about treatment
options.

Starting July 7, Provider Inquiry Will Use One Mailing Address for Blue Cross Commercial Routine Inquiries
As we announced in a May 7, 2025, provider alert, starting July 7, 2025, Provider Inquiry will begin using one mailing address for all Blue Cross Blue Shield of Michigan commercial routine inquiries that can’t be handled by phone for health care providers in Michigan and outside of Michigan.

For inquires that can’t be handled by phone, submit all routine inquiries to the following address to ensure they are handled as efficiently as possible:

Provider Inquiry
Blue Cross Blue Shield of Michigan
P.O. Box 2227
Detroit, MI 48231-2227

Routine inquiries regarding claims, eligibility, and benefits can be handled more quickly and efficiently by calling Provider Inquiry. To speak with a Provider Inquiry representative, call one of the following numbers from 8:30 am to 5 pm Eastern time Monday through Friday:

 

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