Blue Cross Blue Shield of Michigan provider Alert ,, behavioral health (Autism spectrum disorder) see attachment


Newaygo, MI
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FYI if you haven't heard yet!!! See the attachment this was posted on Webdenis under broad cast messages Provider alert Blue Cross commercial and BCN commercial Categories: Authorizations/referrals, Behavioral health, Billing/claims/coding Date posted: May 18, 2022 / Updated May 20, 2022 1 Update: We’re removing age limits for autism spectrum disorder services We updated an earlier communication to reflect that the removal of age limits for ASD services doesn’t affect physical, occupational and speech therapy for members age 19 or older. For BCN commercial members age 19 or older, PT, OT and ST continue to require prior authorization from eviCore healthcare®. We’re removing age limits for ASD services, including applied behavior analysis, or ABA. This change is retroactive to Jan. 1, 2022, to ensure continued access to treatment for Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members whose plan benefits include ABA treatment, other autism services or both. For dates of service on or after Jan. 1, 2022, we’ll reprocess claims for ASD services that were rejected due to age limits. You don’t need to resubmit the claims. Members who aged out of eligibility for ASD services in 2022 will remain eligible to continue receiving ASD services that are medically necessary. Background Previously, following State of Michigan legal guidelines, children aged out of eligibility for certain ASD services when they turned 19. We’re updating our benefits to allow members over the age of 19 to receive these ASD services when medically necessary. We’re making this change because recent medical evidence indicates that age limits are no longer an appropriate method for determining whether ABA treatment is medically necessary. This change is consistent with recent guidance from the Michigan Department of Insurance and Financial Services, or DIFS, and the federal government. Additional information We’re updating our Autism Spectrum Disorder Services medical policy and provider communications — including provider manuals — to reflect this change. We’ll update our certificate and benefit documents to reflect this change by Jan. 1, 2023. eviCore healthcare® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services.


  • alert-20220518-bh-autism-removing-age-restrictions.pdf
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