News & Media
Reimbursement Advocacy Alert
The Michigan State Medical Society (MSMS) Health Care Delivery Department receives news from several of Michigan’s health plans and insurers related to policies, programs, and education opportunities. Below are some updates which may be of interest to physicians and other health care team members.
HAP Diabetes Prevention Program for Your Medicare Patients
The Diabetes Prevention Program is a Centers for Medicare & Medicaid Services (CMS) mandated program offered by HAP in partnership with the National Kidney Foundation of Michigan. Members meet through online workshops that focus on nutrition and physical activity. Trained lifestyle coaches lead classes that are small and supportive by design.
This program is available to all HAP Medicare Advantage members. You can find coverage criteria information in HAP’s policy. Just log in at hap.org, select More, Benefit Admin Manual and search for Diabetes Prevention Program for Medicare Plan Members.
To refer your patients to this program, click here. For more information on the Diabetes Prevention Program, please call (800) 482-1455, or email preventdiabetes@nkfm.org.
HAP Reminder - Claims Appeal Timeframe
Providers have 60 days from the date of the original claim denial to submit a valid appeal. Here is how you can find the denial date:
- On the remittance advice (RA).
- If you received an audit determination letter, the denial date is 60 days from the date of the letter, not the RA date.
You can also find a detailed explanation of the denial:
- On the RA.
- Online by logging in at hap.org, selecting Claims and then the specific denied claim.
- By calling HAP Provider Inquiry at (866) 766-4661.
Any claim appeal submitted past the 60-day appeal timeframe will be closed. No review will be made. These denials cannot be billed to the patient.
You can find more information on the claims appeal timeframe in the HAP Provider Manual-Billing & Administrative Guide for Commercial & Medicare Advantage Plans.
BCBSM/BCN Reminder Regarding the Collection of Applicable Deductibles, Copayments from Members Upfront
Participating providers must bill Blue Cross Blue Shield of Michigan and Blue Care Network for all covered services and may only bill members for their applicable deductibles and copayments. In keeping with provider contracts, you may not collect deposits or bill members upfront for unpaid balances of covered services.
The following guidance comes from the “Patient Copayment and Deductible Requirements” chapter of the Blue Cross Commercial Provider Manual.
- Verify member copayments and deductibles through the provider portal Availity Essentials™ or Provider Inquiry before collecting them.
- Collect known cost-sharing amounts, such as copayments and unmet deductibles, up to the amount of the member’s liability.
- You may not collect the difference between the Blue Cross approved amount and provider charges, also referred to as balance billing.
- Don’t mandate that patients provide credit card information to secure any future balance. (Patients may voluntarily do so.)
BCN Advantage℠ Update: Office, outpatient E/M visit complexity add-on code G2211
In June, Blue Care Network communicated that the Centers for Medicare & Medicaid Services added information on how to use procedure code G2211 with modifier 25 for certain Medicare Part B services starting Jan. 1, 2025, and that their systems were updated to accommodate the changes in May 2025. System updates occurred later than initially communicated but were completed in June. The affected claims, which were professional claims, will be reprocessed.
To avoid duplicate claim denials and delayed processing, don’t resubmit claims. Please allow up to eight weeks for reprocessing of affected claims.
Other BCBSM Articles of Interest