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Pfizer Oncology Together

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MSHO Featured Corporate Sponsor Assistance Programs

• MyNovocure
• SpringWorks CareConnections
• YourBlueprint

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WPS Oncology Related LCD Updates

• New and Retired Policies / Articles
• Proposed LCD Open Meeting

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WPS Recent Oncology Related News

• Transferring Medical Review Responsibilities for Short Stay Claims
• Medicare Hot Links

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WPS Educational Offerings

New training opportunities available

New! Live Training
New! Prior Authorization Education Videos
New! Training Indicators
New! YouTube Chapters

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CMS-Medicare

Recent Oncology Related Articles

• CMS Innovation Center Highlights
• NCCI Third Quarter Edit Files
• FY 2026 ICD-10 codes
• MLN Matters
• And More

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QPP

• Improvement Activities Performance Category
• 2025 MIPS Exception Application Now Available
• 2025 MIPS MVPs Registration Now Open
• CAHPS for MIPS Survey Registration Now Open
• Preview is Open

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Recent RAC Monitor Article

This edition includes articles on

• AI’s Rise in Diagnostic Medicine: A New Frontier
• Leveraging the QIO for Patient-Level Appeals Under MA Final Rule
• Why Price Transparency is a Rare Unifying Issue
• Audio-Only Telehealth: Coding Risks and Documentation Must-Haves
• And More

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BCBSM/BCN

Recent Oncology Related News

• Update to Retacrit and Procrit Maintenance Dose Billing Issues
• July 1 - Fees for New Telemedicine E/M Procedure Codes
• Aug. 1 - Changes to How we Cover Revlimid
• July 7 - One Address for Commercial Routine Inquiries

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

New Update! Retacrit and Procrit Maintenance Dose Billing
• 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

• June 2025 OfficeLink Update
• 2025 Formulary Exclusions Drug List 

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Health Alliance Plan

• Preferred Provider for Home Infusion of Specialty Medications
• HAP CareSource Monthly Updates
• Plans Offered Through HAP CareSource
• Monthly Reminders

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Molina

Recent Oncology Related News

• Preferred Drug List

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Priority Health Update

• Mandatory Action for Prism Security Administrators
• Reprocessing 2025 CRNA Claims Due to Payment Error
• Updated 2025 HEDIS Provider Reference Guide
• Exact Sciences Colorectal Cancer Screening Campaign
• And More

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United Healthcare

• Medical Policy Updates
• Reimbursement Policy Updates
• Pharmacy and Clinical Updates
• Specialty Medical Injectable Drug Program Updates

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Recent Oncology Related FDA Approvals and Expanded Indications

Merck Keytruda (pembrolizumab)
Nuvation Bio Ibtrozi (taletrectinib)

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ASK MSHO

June 2025 Frequently Asked Questions

• Billing for Hydration
• Billing for Subcutaneous Injection of Insulin
• Flushing a Patient’s VAD

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