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BLUECONNECT
Providers
September 2023
In This Issue
► September news: Executive summary
► Commercial plans transition to MCG care guidelines
► We're streamlining our 2024 HMO product options
► Secondary code edits implementing in November
► Learn + earn credits: Lifestyle medicine and nutrition
Take our Stigma-Free AZ pledge
September news: Executive summary
Expansion of partnership with MCG Health
Blue Cross® Blue Shield® of Arizona (AZ Blue) is expanding its use of MCG care guidelines for clinical coverage decisions. In addition to using MCG for Medicare Advantage plans, we will use MCG instead of InterQual® for our commercial plans. This change applies to service dates on and after November 1, 2023. Learn more.
Important: PCP referral approvals are waived for the remainder of 2023 
For PCP-HMO plans, we’re extending the waiver of the PCP referral approval requirement through December 31, 2023. Although we’re waiving the referral approval process, we still require in-network referrals for specialist office visits. To see what’s in store for 2024 HMO plans, please see the 2024 HMO plan options article in this edition.
Quick updates and reminders for your teams
  2024 changes for HMO product offerings
Check out how we’re redesigning HMO product offerings for 2024. Most of our commercial HMO plans will be “open access” and only one will be a PCP Coordinated Care HMO (PCP-HMO) plan requiring PCP referrals. We’re also consolidating the HMO networks for Medicare Advantage plans. Learn more.
Secondary code edits to start in November
We’re partnering with HealthEdge to implement secondary code edits through the HealthEdge Source® platform. We will begin implementing the edits in November, starting with Medicare Advantage claims. Learn more.   
We're adding qualifying providers to the Gold Card Prior Authorization Program
Each month, we’re reviewing our clinical data to determine which providers have met the requirements to be added to the Gold Card Prior Authorization Program. Qualifying providers are invited (via email) to participate in the program as of the first of the following month. For more information about the program and our selection criteria, see the program policy and procedures and visit our Gold Card information webpage.  
CEU opportunities (at no cost)
1. Join us for the October 11 Arizona Community Grand Rounds session: Transforming Mental Health Service Delivery: A Conversation with Tom Insel, M.D. (psychiatrist and neuroscientist; national leader in mental health research, policy, and technology; and author of Healing: Our Path from Mental Illness to Mental Health). REGISTER NOW.
2. Check out this opportunity to learn more about helping patients modify lifestyle behaviors as a way to prevent, treat, and even reverse the progression of chronic disease. This complimentary course from the American College of Lifestyle Medicine offers 5.5 CME/CE hours. Your participation will help us work together to drive down chronic disease in Arizona. Get the details and REGISTER NOW.
3. Reminder: BCBSAZ Health Choice will launch Mountain ECHO Academy in October 2023. The virtual “all-teach, all-learn” educational sessions will be held on the first, second, and third Monday of the month, from October 2023 through May 2024. Mountain ECHO programs offer one CEU per session at no cost.
Substance Use Disorders – first Mondays, noon-1 p.m.
Trauma in Children – second Mondays, noon-1 p.m.
Social Determinants of Health – third Mondays, noon-1 p.m.
Learn more and REGISTER NOW at Mountain ECHO – BCBSAZ Health Choice (healthchoiceaz.com). After you submit your registration, you'll receive your invitation(s) within a week.
4. The American Diabetes Association® is offering CEU opportunities (at no charge) for behavioral health providers who work with patients living with or at high risk for diabetes. Learn more and REGISTER NOW.   
Secure azblue portal tips
• Checking eligibility and benefits: Be sure the member ID prefix used in your inquiry is valid for the date of service. Alternatively, you can use the “Name” search option. For more information about our 2023 prefix replacements for certain members, visit the azblue.com/prefix page.
• Accessing online remits: You can now search remits by Check/EFT Number. Also, using a narrow date range (within the same calendar year) can optimize your search results.
For more information about these updates, contact us at 602-864-4231 or 1-800-232-2345, ext. 4231, or reach out to your provider liaison.
In This Issue
► September news: Executive summary
► Commercial plans transition to MCG care guidelines
► We're streamlining our 2024 HMO product options
► Secondary code edits implementing in November
► Learn + earn credits: Lifestyle medicine and nutrition
Take our Stigma-Free AZ pledge
Blue Cross, Blue Shield, the Cross and Shield Symbols, MyBlue, BlueCard, Federal Employee Program, and FEP are registered service marks, and BluePathway and BlueJourney are service marks, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

The MCG care guidelines are the proprietary and copyright-protected information of MCG Health, part of the Hearst Health network. 

InterQual is a registered trademark, and InterQual criteria are the proprietary and copyright-protected information, of Change Healthcare LLC (part of Optum) and/or one of its subsidiaries.

HealthEdge is a separate, independent company contracted with AZ Blue for claim processing technology. Burgess, a HealthEdge technology company, has developed HealthEdge Source, a single-source claim editing platform.

American Diabetes Association is a trademark of American Diabetes Association, Inc.

© 2023 Blue Cross Blue Shield of Arizona, Inc. All rights reserved.


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