MPAA JAN 2015

• Prisoner Health System (CORIZON’S)

• If BCBSM is primary, group will be 71499/1000• If Medicaid is primary, typically I/P claims, 71499/2000

MPAA JAN 2015

MPAA JAN 2015

• Nursery charges for Healthy Newborns

- Baby does NOT need to be on the contract for it to pay on Underwritten groups, (individual contracts or self funded groups may require the baby to be on the contract. If you received a rejection, you can now call these into PIO for reprocessing.

• Billing Observation, when not admitted from ED setting. Bill the first hour as G0379 1 Unit. Greater than 1 hour, bill the remaining hours under G0378 – xx Units.

• Ford Salaried groups no longer use Theramatrix as their claim processor, BCBSM resumed Ford’s O/P PT, so if you are a BCBSM participating provider, you would be “in-network” for Ford Salaried members.

MPAA JAN 2015

• Intensity modulated radiation therapy of the:– Breast and lung or of the Prostate – Abdomen & pelvis– Prostate– Central nervous system tumors– Head and neck cancers

Certain criteria needs to be met for each circumstance, HCPCS 77301, 77338, 77385, 77387.

• Make sure you are billing OPT correctly – Each DOS + HCPCS

+ Quantity of that HCPCS.

MPAA JAN 2015

• Important RECORD Articles– Jan 2015 – BCBSM will discontinue paying for Medical Records for Value

Partnership data gathering, reimbursement is in the bonus money.

– Jan 2015 – Blue’s Narrow Networks, Metro Detroit EPO & HMO Networks, pay close attention to what your facility par’s with.

– Jan 2015 – Medical Policy Updates – Mainly CRNA’s payable procedures have expanded, there is a listing of payable hcpcs.

– Jan 2015 - In Hospital Sleep Studies now require Accreditation by a designated Sleep Study Accrediting Body.

– Jan 2015 - BCBSM Med Adv will recognize new Modifiers with 59, XE – XP – XS - XU

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Questions

MPAA JAN 2015

MPAA JAN 2015