11/19/2025

BCBSM/BCN

Publications

November 2025 Issue Available HERE.

Important Articles to Note:

Closing HEDIS gaps for medication compliance, vaccines

Clinical editing updates: Transfer discharge status codes; denial code K518; complex drug administration coding

Include NDCs on claims for gene, cellular therapy drugs for commercial members for faster, more accurate processing

Changes to prior authorization requirements for select services managed by Blue Cross, BCN started Sept. 28

Billing chart: Blue Cross highlights medical, benefit policy changes

We’re updating eligible claims for high-dollar prepayment review to include our Medicare Advantage plans

November/December Issue Available HERE.

Important Pages to Note:

Pg. 13  Webinars for physicians, coders focus on documentation, coding

Pg. 21  Change to copay & coinsurance for oral chemotherapy for some commercial members, starting Jan. 1

Pg. 22 Medical policy updates

Pg. 28 Pharmacy news roundup

Pg. 29 Select requesting provider when submitting prior authorization requests in Medical and Pharmacy Drug PA Portal

Pg. 34 Osenvelt and Stoboclo will be the preferred denosumab biosimilar products for most commercial members starting Dec. 15

Pg. 36 Osenvelt and Stoboclo to be preferred denosumab products for Medicare Advantage members, starting Dec. 1

Pg. 38 Include NDC codes on claims for gene and cellular therapy drugs for commercial members for faster and more accurate processing

Pg. 41  We’re making some changes to how we cover some medications on the drug lists associated with our prescription drug plans, starting Jan. 1