News & Media
Reimbursement Advocate Alert: February 2026
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.
BCBSM/BCN News
BCN Webinars
Blue Care Network (BCN) is offering live educational sessions, focused on documentation and coding. Attendees will have an opportunity to ask questions. Sessions start at 12:00 pm and run for either 30 or 45 minutes. Register on the provider training website. Read more.
Authorizations Issued for Medicare Plus Blue Members Transitioned to NASCO
Blue Cross Blue Shield of Michigan (BCBSM) moved their large groups and remaining national Michigan group membership to NASCO, effective January. 1, 2026. Read more.
Billing Chart: Blue Cross Highlights Medical, Benefit Policy Changes
The latest information about procedure codes and BCBSM billing guidelines are in the “Billing chart.”
The billing chart is organized numerically by procedure code. Newly approved procedures will appear under the New Payable Procedures heading. Procedures for which BCBSM has changed a billing guideline or added a new payable group will appear under Updates to Payable Procedures. Procedures for which BCBSM is clarifying their guidelines will appear under Policy Clarifications. New procedures that are not covered will appear under Experimental Procedures.
Information about new Blue Cross groups or changes to group benefits will be published under the Group Benefit Changes heading. See full February 2026 The Record Article for additional information.
Verification Required for HAP Medicare Diabetes and Heart (HMO C-SNP)
On January 1, 2026, Health Alliance Plan (HAP) introduced a new plan—HAP Medicare Diabetes and Heart (HMO C-SNP). It is a Medicare Advantage plan specifically designed for individuals with certain chronic health conditions. The plan focuses on:
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Diabetes Mellitus
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Chronic Heart Failure
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Cardiovascular Disorders Cardiac Arrhythmias
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Coronary Artery Disease
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Peripheral Vascular Disease
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Chronic Venous Thromboembolic Disorder
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Ensure Your Patients Keep Their Coverage
Physicians are required to verify their HAP Medicare Diabetes and Heart (HMO C-SNP) patient has been diagnosed with one or more of the chronic conditions above. If HAP does not receive verification within 60 days of the patient’s enrollment, the patient will be automatically disenrolled.
If a patient under your care submits a HAP Provider Verification of Chronic Condition form to your practice for verification, the steps to complete are:
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Log in hap.org
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Select More
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Select C-SNP Chronic Condition Form
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Complete fields and submit
Contracted providers are eligible for a $250 incentive per completed form that is returned to HAP. Payment will be made quarterly. Effective March 2, 2026, the incentive only applies to forms submitted using their online tool.
For more information about this plan, visit hap.org.
HAP - Prior Authorization for J9172 and J9174
Effective April 1, 2026, the codes below will require prior authorization for members in HAP Medicare Advantage plans, HAP Commercial plans and HAP Qualified Health Plans (off-exchange).
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J9172: Injection, docetaxel (ingenus) not therapeutically equivalent to j9171, 1 mg
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J9174: Injection, docetaxel (beizray), 1 mg
Non-Covered Codes – HAP Commercial and Qualified Health Plans (Off-Exchange) Only
Effective April 1, 2026, the codes below will not be covered under the medical benefit. These codes represent specialty, self-administered drugs. Consult the patient’s respective formulary for coverage status under the pharmacy benefit.
If physicians have questions regarding the above changes, please call the HAP Pharmacy Care Management department. They can be reached at 313- 664-8940, Monday-Friday, from 8:00 am - 4:00 pm.
McLaren News
Provider Communication: Prior Authorization Document Updates
McLaren updated their Prior Authorization document to include dental services (page 48) and contact information for ModivCare, their transportation partner (page 15). This will be posted online at: mclarenhealthplan.org > Providers.
If practices have any questions, contact your Provider Relations Representative or Customer Service at 888-327-0671.
Payment Policy and Authorization Updates
McLaren Health Plan recently released payment policy and authorization updates. These will be posted online soon at: mclarenhealthplan.org > Providers. Refer to the MHP Provider Manual to navigate administrative processes and covered services. For questions, contact Customer Service at 888-327-0671.