09/15/2025

[Duplicate] BCBSM/BCN

Publications

July 2025 Issue Available HERE.

A Few Articles You Will Want to Check Out: 

• Reminder: Follow these requirements when billing for noncovered services 
• Clinical editing updates: IMRT billing rules; sequela codes; clinical editing portal; add-on code G2211
• Update: Medicare Advantage prior authorization requests submitted through NovoLogix must be submitted through different application, starting Aug. 1 
• Answers to questions about changes to requirements for pain management procedures for our Medicare Advantage members  
• Submit clinical documentation through Medical and Pharmacy Drug PA Portal 
• Starting Oct. 6, submit prior authorization requests for FEP members through the e-referral system
• Pharmacy news roundup 
• Starting Sept. 1, we’ll change how we pay for certain medications for most Blue Cross, BCN commercial members 
• We’re changing how we manage self-administered hemophilia products for most Blue Cross, BCN commercial members, starting Sept. 1 
• Webinars for physicians, coders focus on documentation, coding 
• Reminder: Participating providers may only collect applicable deductibles, copayments from members upfront 
• 2025 HCPCS 2nd-quarter update: New, deleted codes 
• HCPCS replacement codes established, effective July 1, 2025 
• Billing chart: Blue Cross highlights medical, benefit policy changes 

July/August Bi-Monthly Issue Available HERE.

A Few Articles You Will Want to Check Out:

• Medical policy updates (Page 14)  
• Behavioral health providers shouldn’t submit claims for behavioral health collaborative care services (Page 18)  
• Pharmacy news roundup (Page 21)  
• Bill HCPCS code J3490 for Depo-Provera for commercial members (Page 22)  
• HelpScript enrollment service for manufacturer copay assistance will start July 1 for select medical benefit drugs for some BCN commercial members (Page 22)  
• We’re changing how we cover Revlimid, starting August 1 (Page 24)  
• Fees for new telemedicine E/M procedure codes to start July 1 (Page 25)  
• 2025 billing changes affect provider-delivered care management services (Page 27)  
• Claims status inquiry process (Page 28)  
• Reminder: Follow correct billing guidelines when submitting claims for secondary payment (Page 31)  
• Coding corner: Acute conditions not typically managed in office setting (Page 32)  
• Clinical editing updates (Page 33)  
• Medicare Advantage members can request a non-emergency transfer from one acute care facility to another at any time (Page 35)  
• Preview questionnaires and medical necessity criteria (Page 39)