Medicare Plus Blue Changes in Michigan effective Jan 1, 2018
Action Items? YES
Bottom line: Blue Cross of Michigan is contracting with Northwood to manage their Medicare Plus Blue DME benefits starting Jan 1, 2018; and you may have an action item to take care of before then!
Vocab: Blue Cross refers to their Medicare Advantage insurance product (Medicare Plus Blue) as MAPPO which stands for Medicare Advantage PPO.
- Where to send claims: continue submitting claims to BCBSM, but this will change in the future; date TBD.
- Where to get auth’s from: continue requesting prior authorization from BCBSM, but this will change on a future date TBD where Northwood will require auth for ALL EQUIP & SUPPLIES. :/
- Do we have to start rental periods over? No!Treat them as you normally would on Jan 1st as if the contract manager had not changed.
- Not a Northwood Provider? Might be time to make a phone call! 586 755-3830 or 800 447-9599 x 3703
U-DECIDE: Blue Cross of Michigan reps have indicated to our HDMS A-Team members that once Northwood assumes claims processing in the future (date TBD) that they will only process claims with dates of January 1st, 2018 and forward- and that BCBSM will continue to process any claims prior to 2018 that are left open.
HDMS Impact: When that split happens, if you were to simply go into your Medicare Plus Blue payer and change the claims mailing address, EDI info, and PA form it would change the info for all claims regardless of DOS. This will prevent you from creating the division you may need.
Universal best practice recommends that you create a new Medicare Plus Blue Northwood payer for any account where claims will be created on or after 1/01/2018. Here are the things you need to note:
- New Payer should use the same Payer Type & Procedure Group as your existing Medicare Plus Blue Payer
- By creating a new payer that follows the same payer type and procedure group rules, you are ensuring that existing rentals will not be interrupted. Choosing different options may be detrimental to your active rentals.
- Use the “Patient Insurance Report” in HDMS under Reports> Account & Patient Reports to identify all accounts with existing Medicare Plus Blue payer that may need to have your new 2018 Medicare Plus Blue Northwood payer entry added to their account.
- Be sure to put an expiration date in your existing Medicare Plus Blue account entry of 12/31/2017 and an effective date on your new entry of 1/01/2018.
Source Document: BCBSM MAPPO NW Frequently Asked Questions_10212017_FINAL
Please contact Universal Support with any additional questions. Thank you!