; Silver Sneakers - where seniors have free access to nearly 200 fitness centers; Care Reminders ; Blue365 - Discounts & deals on gym memberships, fitness gear, healthy eating options, & more. DETROIT, Apr. This plan includes additional Medicare prescription drug (Part-D) coverage. Find medical policy for Blue Shield of California plans. Policies and Practices - Blue Cross Blue Shield of Michigan Medical Policies - Horizon Blue Cross Blue Shield of New ... Blue Cross Blue Shield Medicare Supplements in Michigan • For Blue Cross commercial and Medicare Plus Blue members: Provider Preauthorization and Precertification Requirements • For BCN commercial and BCN Advantage members: Non-Michigan providers: Referral and authorization requirements You can view these documents and our medical policies through the . Search for a medical policy by name, CPT code or keyword.. Medical Policy Updates. medicare. AIM-Managed Procedures. To Top. Reimbursement policies for Blue Cross and Blue Shield of . Michigan has a robust Medicare Advantage market, with at least 12 plans available statewide, and more than 50 in some counties. There are 29 stand-alone Part D prescription plans available in Michigan in 2021, with premiums that range from about $7 to $109 per month. Drugs that require prior authorization. This policy and any information contained herein is the property of Blue Cross Blue Shield of Michigan and its subsidiaries, is strictly confidential, and its use is intended for the P&T committee, its members and BCBSM employees for the purpose of coverage determinations. Site Map. By accessing this Medical Policy Manual, you acknowledge receipt and agreement with the information below. Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc. (collectively referred to as "BCBSLA") have developed these medical policies to serve as general coverage guidelines for determining if a particular treatment, procedure or other service may be considered as a covered benefit. The patient initiates the medical or behavioral health evaluation. We hope this will be both convenient and helpful to you in caring for your patients. To aid in the . You can find which drugs need prior authorization by viewing our Medicare Advantage Medical Drug Prior Authorization and Step Therapy List (PDF). The Medicare Plus Blue PPO Essential (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $6,000 (MOOP). To see a list of all Medical Policies and Clinical UM Guidelines, visit our Full List page. Free Health Programs. Our Medicare Plans Earn CMS Top Ratings For 2022, Blue Care Network HMO received Medicare's highest star rating. The Medical Policies contained within this website do not apply to Medicare Advantage network members. For 2022, Blue Cross PPO received 4.5 out of 5 stars. The Medical Policy Portal offers streamlined navigation to the various types of policies available. High-tech radiology - This includes procedures for Michigan Blue Cross and Blue Shield Federal Employee Program ® members, for dates of service on or after Feb. 1, 2021. Medicare Plus Blue℠ PPO plans follow most original Medicare guidelines. Our 5-star ratings are unbiased. Medical Policies The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. Medicare Plus Blue PPO Essential (PPO) H9572-004 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross Blue Shield of Michigan available to residents in Michigan. Blue Cross Blue Shield of Michigan covers 4 weight loss procedures, including the Gastric Sleeve, Gastric Bypass, and Duodenal Switch, assuming your policy includes bariatric surgery. The member's benefit plan determines coverage. It also lists generic and brand names for each drug. Medicare Plus Blue PPO Assure (PPO) H9572-003 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross Blue Shield of Michigan available to residents in Michigan. Blue Cross Blue Shield (BCBS) is a nationwide insurance provider that may cover rehab for drug and alcohol addiction depending on your plan and individual needs. These Medical Policies describe when medical services are considered medically necessary, not medically necessary or investigational. Medicare Plus Blue PPO Essential (PPO) H9572-004 is a 2022 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross Blue Shield of Michigan available to residents in Michigan. Medical Policies (Medical Coverage Guidelines) We strive to cover procedures, treatments, devices and drugs proven to be safe and effective for a particular disease or condition and continually look at new medical advances and technology to determine for coverage and payment purposes if any is superior to those already in use. Part A hospice care coinsurance payment or co-payment. Description for the health care coverage under the Medical Benefit Program (including the Prescription Drug Program) component of Plan 504 of the Trinity Health Corporation Welfare Benefit Plan (THWBP) that is provided through the Blue Cross Blue Shield of Michigan ("BCBSM") Preferred Provider Last updated on 10/4/2021 . Medicare Plus Blue PPO Vitality (PPO) H9572-002 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross Blue Shield of Michigan available to residents in Michigan. Plans Offered by Blue Cross Blue Shield of Michigan Attained Age Rated Medigap Plans: With this plan rating type your monthly premium is based on your current age. I have read and I agree to the disclaimer. Medical policies for Medicare Advantage members: We are required to make coverage determinations for services . BCBSMI and Blue Care Network are the largest insurer of private insurance in the state of Michigan, according to the Kaiser Family Foundation. More information can be found in the U.S. Preventive Services Task Force Guide to Clinical Preventive Services. Part A is premium-free for most people, but for those who haven't paid . Medical policy list. Medical Policy Information for Out-of-Area Members. Medical Policy & Pre-Cert/Pre-Auth Router. Medicare Advantage Medical Policy Medical policy information that is appropriate for our Medicare Advantage product. Medical Policy. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. We review all major Medigap insurance carriers selling policies in Michigan. Plans are insured and offered through separate Blue Cross and Blue Shield companies. Medicare Plus Blue PPO Signature (PPO) H9572-001 is a 2022 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross Blue Shield of Michigan available to residents in Michigan. Find out who to contact for questions about Blue Cross NC's medical policies. Policies are intended to be used for some or all of the following purposes in Blue Cross and Blue Shield's administration of plans: (i) adjudication of claims (including pre-admission certification, pre . Page 1 of 6 Where sold, Blue Cross Blue Shield of Michigan's Plan C policy offers the following coverage: Medicare Part A hospital coinsurance and hospital costs up to 365 days after Original Medicare benefits are exhausted. In Michigan, nearly 1.1 million people are enrolled in Original Medicare, which is comprised of Part A, or hospital coverage, and Part B, or medical coverage. May 2021 BCBS Michigan Medical Policy Updates: Accelerated Breast Irradiation after Breast-Conserving Surgery for Early Stage Breast Cancer and Breast Brachytherapy as Boost with Whole-Breast Irradiation Aqueous Shunts and Stents for Glaucoma Automated Point-of-Care Nerve Conduction Tests They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. If seniors keep unlimited medical coverages, the auto insurer will pay for the services that Medicare would not cover. Access Medical Policies relating to Medicare Advantage. Y0074_2022BCBSMHmPg_M CMS Accepted 10272021 Click here to view the Blue Cross Blue Shield BCBS Florida Medical Policy Updates » Policy Alerts monitors Commercial and Medicare medical policies for changes. Spectrum Health, which is already a network provider for Blue Cross and Blue Care Network commercial plan members, as well as… Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern . Instead, facilities are encouraged to follow the two-level provider appeal process for Medicare Plus Blue to reevaluate the denial decision on an inpatient admission request. Important Information About Medicare Plans ©1996-2021 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. This plan includes additional Medicare prescription drug (Part-D) coverage. The purpose of the Horizon Medical Policy Manual is to provide clinical policies applicable to the administration of health benefits insured or administered by Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc., Horizon Insurance Company, and Healthier . The internet is full of information about traditional providers of Medicare Plan F policies, like Blue Cross Blue Shield of Michigan. Snowbird Travel Program: Medicare Coverage that Flies South With You. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. Provider Directory. Medical Policies Disclaimer. That's why we've compiled all the information you need about your CPAP insurance coverage under your bcbstx health insurance plan. Use these alphabetical lists to find Blue Shield medical policies, and review requirements and criteria for new technologies, devices and procedures. Searching for a medical policy? Get the latest updates to Blue Cross NC's medical policies.. Medical Policy Contact Information. Benefits are payable in cases of medical necessity and only if services or supplies are not investigational. Cardiology services - Medicare Plus Blue SM. Report Site Issues. . The Medical Policies you are about to view are the property of Blue Cross Blue Shield of Nebraska (BCBSN). A premium is an amount that an insurance policyholder must pay for coverage. Description for the health care coverage under the Medical Benefit Program (including the Prescription Drug Program) component of Plan 504 of the Trinity Health Corporation Welfare Benefit Plan (THWBP) that is provided through the Blue Cross Blue Shield of Michigan ("BCBSM") Preferred Provider This page explains the coverage requirements, plan types, and covered procedures, as well as how to appeal a denial. Medical policies, which are based on the most current research available at the time of policy development, state whether a medical technology, procedure, drug or device is: This flexibility allows . Disclaimer: Benefits are payable under Blue Cross and Blue Shield of Alabama health plans only in cases of medical necessity and only if services or supplies are not investigational. Medigap (Medicare Supplement) If you are enrolled in Medicare Part A and B (Original Medicare), Medigap plans can help fill the coverage gaps in Medicare Part A and Part B. Medigap plans are sold by private insurance companies and are designed to assist you with out-of-pocket costs (e.g., deductibles, copays and coinsurance) not covered by Parts A and B. They are often used as guidelines for coverage determinations in health care benefit programs. Medicare is the federal health insurance program for those aged 65 and over or who have a qualifying disability. Determining whether Blue Cross commercial members require prior authorization through Northwood (PDF) Durable medical equipment and prosthetics and orthotics: For authorization determinations (PDF) Diabetes: For coaching, management, behavioral counseling and supplies (PDF) - Includes information about care management and utilization management . It includes Healthcare Common Procedural Coding System, or HCPCS, codes. This plan includes additional Medicare prescription drug (Part-D) coverage. coverage to Medicare-eligible Michigan residents and Medicare-eligible members of Blue Cross groups. Change Healthcare's InterQual ® criteria are available on request by calling Provider Services at (651) 662-5000 or 1-800-262-0820.. MHCP medical policy grid (see 'Medical Policy Grid' under 'Medical Policies and Clinical UM Guidelines'). Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. Once you accept the terms and conditions below, you'll be connected to the Medical Policy Portal. July 2021 BCBS Michigan Medical Policy Updates: Absorbable Nasal Implant for Treatment of Nasal Valve Collapse Actigraphy Allergy Testing and Immunotherapy Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening Antigen Leukocyte Antibody Test Artificial Pancreas Device Systems Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists:. Official Site of Anthem Blue Cross Blue Shield, a trusted health insurance plan provider. These guidelines are available to you as a reference when interpreting claim decisions. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Title Last Updated Category Abdominoplasty and Panniculectomy Open a PDF 7.01.53 2021-05-21: Cosmetic / Reconstructive Surgery Medical policies and clinical utilization management guidelines help us determine if a procedure is medically necessary. Contact Us. Additional information about our medical policies. Structured as a non-profit organization, the company was founded in 1929. Medicare Part B co-payment or coinsurance payment. Elder Law of Michigan, Inc. (ELM), a 501(c)(3), is a nonprofit charitable organization that promotes and protects the rights, health, and economic well-being of older adults and people with disabilities Structured as a non-profit organization, the company was founded in 1929. As an example, if you enroll in a Medigap policy at age 65 with a premium of $120, it may increase to $138 when you turn 69, and $162 at age 72. Upcoming medical policy notifications. Blue Cross Blue Shield of Michigan offers Medicare Supplements (or Medigap plans), Medicare Advantage, and Medicare Part D programs. For medical oncology and supportive care drugs, AIM Specialty Health ® manages the prior authorization process. For UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, submit prior authorization requests . The Medicare Plus Blue PPO Assure (PPO) has a monthly premium of $200.00 and has an in-network Maximum Out-of-Pocket limit of $3,425 (MOOP). Shop plans for Medicare, Medical, Dental, Vision & Employers. In the United States, Puerto Rico and U.S. Virgin Islands. The online Medical Policy Reference Manual contains approved medical policies and operating procedures for all products offered by CareFirst. Providers should be knowledgeable about BCBSIL Medical Policies. Medical policies for Federal Employee Program members: Find them on fepblue.org. From there, simply click the applicable policy portfolio (i.e., Commercial, Medicare Advantage, MAPPO Host) from the selections across the top of . BCBSMI and Blue Care Network are the largest insurer of private insurance in the state of Michigan, according to the Kaiser Family Foundation. Outside the United States. Blue Cross Blue Shield (BCBS) of Michigan is a Medicare-contracted private insurance company that offers you an alternative way to get your Original Medicare benefits through its wide selection of Medicare Advantage plans. This plan includes additional Medicare prescription drug (Part-D) coverage. Michigan BCBS started as the Michigan Society for Group Hospitalization in 1938. Sorting through these insurance carriers on your own can be difficult, and you might miss some of your options, such as lower premiums, perks, and discounts that might be available. There are displayed for? As you age your premium will increase. (423) 535-6705. . Seniors can purchase lower than unlimited levels of PIP medical coverage: $250,000 or $500,000 per person per accident of coverage. Legal Information. Medicare enrollees can elect to keep the unlimited coverages on their auto policies. BCBS of MI to Correct Processing of 88342 Our contact has been working with the Medical Affairs department at BCBS of MI who reported the following: "The quantity limit assigned to procedure code 88342 was re-evaluated by our Associate Medical Director who reviewed the information regarding the correct reporting of the code, including guidelines from essential coding authorities. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. 13, 2021 — Grand Rapids-based Spectrum Health will expand its longstanding, network relationship with Blue Cross Blue Shield of Michigan by joining the Blue Cross Medicare Advantage PPO network beginning July 1, 2021. Please contact your job health vulnerable to cue your soil is a Description for the health care coverage under the Medical Benefit Program (including the Prescription Drug Program) component of Plan 504 of the Trinity Health Corporation Welfare Benefit Plan (THWBP) that is provided through the Blue Cross Blue Shield of Michigan ("BCBSM") Preferred Provider Blue Cross between Blue color of Massachusetts, for dates of care prior to Jan. Home medical policy, michigan plan details when certain state farm is only applicable to search terms of your browser settings menu for a complaint. They have been developed by the BCBSN Medical Policy Committee (Committee) for use by BCBSN in determining the scientific validity of new and existing medical technologies, treatments, devices, drugs, etc. For the best results, search on the medical policy site by category, policy number, procedure code, or alphabetically. Select Blue Cross Blue Shield Global™ or GeoBlue if you have international coverage and need to find care outside the United States. Viewing this Medicare overview does not require you to enroll in any Blue Cross Blue Shield plans. The visit is typically straight forward decision making that addresses urgent but Blue Cross Blue Shield CPAP Therapy Policy Highlights The blue cross and blue shield association's medical policies can be confusing, when it comes to treating sleep disorders. While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. Paper copies of the guidelines are available upon request by calling (423) 535-6705. Some plans exclude coverage for services or supplies that are considered medically necessary. For Medicare members who migrate to warmer and sunnier climates to escape the cold Michigan winters, Blue Cross Blue Shield of Michigan has you covered.Our Medicare Advantage plans are designed to meet the needs of travelers, and we have developed a custom program with snowbirds in mind. Medical Policy Search. If you have health insurance (other than Medicare or Medicaid) and you want to save money on your auto insurance, you have the option in Michigan to buy coordinated/excess medical PIP coverage. To view the out-of-area Blue Plan's medical policy information, enter the first three letters of the member's identification number on the Blue Cross Blue Shield ID card, and click "GO." If you experience difficulties or need additional information, please contact 800-676-BLUE. For Medicare Plus Blue SM members, Blue Cross Blue Shield of Michigan will no longer accept peer-to-peer requests related to inpatient medical hospital admission denials. Third Party Website Icon: Please be aware when you are on the Blue Cross and Blue Shield of Minnesota (Blue Cross) website and see this Third Party Website icon, you will be connected to a third party site, whether via links provided by Blue Cross or otherwise, and you will be subject to the privacy policies of the third party sites. Blue Cross Blue Shield of Michigan - Medical Policy Page 2 An online visit is a type of low complexity clinician interactive visit that requires an audio visual online communication. View medical policy list for Blue Shield of California Promise Health Plan. This group and the Michigan Medical Service changed their names to Michigan Blue Cross and Michigan Blue Shield and these two . We use a complex formula that evaluates years in business, A.M. Best financial strength rating, plans serviced, plan premiums. © 2021 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. ©1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit . Blue Cross Blue Shield of Michigan offers Medicare Supplements (or Medigap plans), Medicare Advantage, and Medicare Part D programs. This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City ("BCBSKC"). We provide health insurance in Michigan. In Michigan, 48 insurers offer Medigap plans. The Medicare Plus Blue PPO Signature (PPO) has a monthly premium of $97.00 and has an in-network Maximum Out-of-Pocket limit of $4,700 (MOOP). This plan includes additional Medicare prescription drug (Part-D) coverage. ©1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. This includes cardiac implantable devices and services, for dates of service on or after Jan. 1, 2021. For information about faxing prior authorization requests, call the Pharmacy Clinical Help Desk at 1-800-437-3803. For this reason alone, anyone with Blue Cross Blue Shield should have primary No-Fault auto insurance as well. Centers for Medicare & Medicaid Services gave Medicare Plus Blue approval to process claims using Michigan local coverage determinations for group plans regardless of location . About BCBS of Michigan. Medicare Plus Blue plans provide at least the same level of benefit coverage as Original Medicare (Part A and Part B) and provide enhanced benefits beyond the scope of Original Medicare within a single health care plan. Baby Yourself - free gifts and a personal nurse offer support for a healthy pregnancy; Talk to a nurse or advisor - do you have questions about your health? Medicare overview information on this website was developed by the Blue Cross and Blue Shield Association to help consumers understand certain aspects about Medicare. The Medicare Plus Blue PPO Vitality (PPO) has a monthly premium of $40.00 and has an in-network Maximum Out-of-Pocket limit of $5,000 (MOOP). Medical Policies Blue Cross and Blue Shield of New Mexico (BCBSNM) Medical Policies are based on scientific and medical research. Visit Anthem.com to learn more about how these policies are used to determine patient coverage and medical necessity. In addition to the active and pending Medical Policies, BCBSIL has included policies which . September 2018 BCBS Michigan Medical Policy Updates: CPT Category III Codes-Noncovered Services Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies Genetic Testing - Gene Expression Testing in the Evaluation of Patients with Stable Ischemic Heart Disease Medical policies are based on constantly changing medical science and Blue Cross reserves the right to review and update our policies as necessary. Blue Cross and Blue Shield of Minnesota Medical Policies.