Michigan

You may use the new Patient Advance Notice of Noncovered Service(s) form with BCN Advantage HMO‑POS, BCN Advantage HMO or Blue Care Network members if you believe BCN Advantage or BCN will deny payment for a service because it is not medically necessary or is not covered. The Patient Advance Notice of Noncovered Service(s) form allows you to inform members that they could be responsible for the costs associated with the service in question and shows the specific amount for which they could be liable.

The Office of Inspector General (OIG) of the Department of Health and Human Services advised in the 2013 OIG Work Plan that they would be reviewing payments for Alien Beneficiaries Unlawfully present in the United States. Audits conducted by the OIG have resulted in overpayments to providers across the country, including those serviced by National Government Services. As a result, CMS has charged National Government Services to begin the process of recouping identified overpayments. The first series of overpayment adjustments have generated.

Effective for dates of service (DOS) on or after January 1, 2013, the current maximum daily dollar limits for laboratory claims will be eliminated. Historically, Medicaid policy has enforced maximum daily dollar limits for laboratory services. Limits were established at $125 for independent laboratories. These limits applied to laboratory services rendered by the same provider, for the same beneficiary, on a single DOS.

A change is being implemented to update and align BCBSM claims filing process. The update requires that all health care providers submit secondary claims, status inquiries and adjustments within 24 months of the date of service, not from the paid or denied date, as previously communicated. Deadline submissions for original claims remain the same – 180 days for professional providers and 12 months for facility providers, from the date of service.