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Providers
October 2023
In This Issue
► October news: Executive summary
► Prosano benefit plans for employer groups for 2024
► RSV, COVID-19, and influenza vaccine coverage
► Changes to Part B Step Therapy program
► Take the #StigmaFreeAZ pledge and spread the word
► Be sure to ask, "When was your last mammogram?"
► CMS: Notifying MA enrollees of provider terminations
Get an update on the AZ 988
Crisis Response Performance
October news: Executive summary
We’re partnering with OptumCare Arizona for certain 2024 Medicare Advantage HMO plans
In addition to the expansion of the Blue Advantage HMO network, we have also contracted with OptumCare Arizona to provide utilization management and claim/payment processing services for a subset of our HMO membership in Maricopa and Pinal counties. These members can be identified by the Optum claim information and prior authorization number on the back of the ID card. Learn more.
Reminder! We start using MCG care guidelines on November 1
On November 1, 2023, Blue Cross® Blue Shield® of Arizona (AZ Blue) will begin using MCG instead of InterQual® for commercial plans. Currently, we only use the MCG care guidelines for Medicare Advantage plans (if there is no applicable NCD or LCD). See details in our September article. 
More updates for your teams
  Secondary code edits to start in early 2024
Our implementation has been delayed. Instead of November, we’ll begin using secondary code edits (HealthEdge Source® platform) in the first part of 2024, starting with Medicare Advantage claims. 
2024 product offerings
Ready for some sneak previews? Here are a few:
• 2024 Affordable Care Act (ACA) plans and networks
• 2024 Medicare Advantage plans and networks
• 2024 Prosano plans and networks
  Have you taken the pledge yet?
Join us in reducing stigma around behavioral health. Learn more.
Our Gold Card prior authorization requests can save you time
For information about how to qualify for our Gold Card program and how to initiate a Gold Card prior authorization, visit our Gold Card information webpage.  
No need to request approval for PCP referrals
For PCP-HMO plans, we no longer require AZ Blue approval for PCP referrals to specialists. In-network referrals are still required for specialist office visits, and the referral information should be included on the claim. If the patient needs care from an out-of-network specialist, you must request prior authorization to ensure coverage.
CEU opportunities (at no cost)
1. Join us for the November 1 Arizona Community Grand Rounds session Addressing Diabetes in Arizona: From Plan to Action. Get an update on the AZ Blue Diabetes Action Plan and hear from the American College of Lifestyle Medicine (ACLM) on proven strategies for diabetes prevention and management. REGISTER NOW. 
2. Check out this ACLM opportunity to learn more about helping patients modify lifestyle behaviors as a way to prevent, treat, and even reverse the progression of chronic disease. Your participation will help us work together to drive down chronic disease in Arizona. Get the details and REGISTER NOW (5.5 CME/CE hours).
3. As part of the 2023 ACEs & Resilience Summit, the Center for Resiliency & Wellbeing is offering a virtual training on December 5 with presenters from across the country on topics related to The Whole Child: Nurturing Health & Wellbeing through Relationship & Resiliency. Learn more and REGISTER (8 CME credits).
4. Still available: Mountain ECHO Academy, for virtual “all-teach, all-learn” educational sessions held on the first, second, and third Monday of the month, through May 2024. Mountain ECHO programs offer one CEU per session.
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.
REGISTER at Mountain ECHO – BCBSAZ Health Choice (healthchoiceaz.com).
5. The American Diabetes Association® is offering CEU opportunities 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 at 602-864-4231 or 1-800-232-2345, ext. 4231, or reach out to your Provider Relations Contact. 
In This Issue
► October news: Executive summary
► Prosano benefit plans for employer groups for 2024
► RSV, COVID-19, and influenza vaccine coverage
► Changes to Part B Step Therapy program
► Take the #StigmaFreeAZ pledge and spread the word
► Be sure to ask, "When was your last mammogram?"
► CMS: Notifying MA enrollees of provider terminations
Get an update on the AZ 988
Crisis Response Performance
OptumCare Network of Arizona (“OptumCare Arizona”) is a separate, wholly owned subsidiary of Optum and is contracted with AZ Blue to provide utilization management and claim/payment processing services for providers and attributed members with certain AZ Blue Medicare Advantage HMO 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.

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.

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


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