August 2018

Medicaid

Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

Check out this month’s Medicaid newsletter to learn about the MCO LTSS provider enrollment deadline extension, how overpayments will be corrected using auto-recoupment, THSteps Quick Reference Guide updates, the new rendering provider NPI requirement, the new EVV review process and more.

New Preventive Service for Medicare Members at Risk for Type 2 Diabetes

Review the eligibility criteria for your BCBSTX Medicare health plan patients to participate in the Medicare Diabetes Prevention program.

Reminders

• Predetermination Request Form Update; Newest Version Required Oct. 1
• Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
• Provider Finder^® Update
• Provider Webinars Scheduled for 2018

Update to the Blue Cross Medicare Advantage^SM Preauthorization List

Review the three Blue Cross Medicare Advantage preauthorization procedure codes that no longer require preauthorization.

ERS Sleep Authorization Requirements

Applies to: HealthSelect^SM of Texas and Consumer Directed HealthSelect^SM

Effective Aug. 1, 2018, the Employee Retirement System of Texas no longer requires prior authorizations for sleep Durable Medical Equipment (DME) resupply codes. Information about this change and the full list of sleep DME codes that still require prior authorization are available on eviCore.com. If you have any questions, please contact your Network Management Representative.

Reminder

• New eviCore^TM Email Notification for Utilization Management Decisions

‘Annual Visit’ Campaign Stresses the Importance of Proper Coding

BCBSTX is launching a preventive care awareness campaign, which may cause increased traffic to your office. This is a friendly reminder that careful medical record documentation for each patient at every visit will help ensure claims accuracy and timely payments.

Reminders

• Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage
• The Keys to Unlocking a Great Discharge Summary
• High-dose Influenza Vaccine Guidelines

Updates to Clinical Payment and Coding Policies

Review the updates to BCBSTX’s clinical payment and coding guidelines, impacting: anesthesia, implants, inpatient/outpatient unbundling, and wasted/discarded drugs and biologicals.

Electronic Replacement/Corrected Claim Submissions

Ensuring claims are properly submitted and adjudicated are important to making sure providers are paid accurately in a timely manner. When submitting electronic replacement or corrected claims, access our updated tip sheet.

BCBSTX Implementing Two ClaimsXten^TM Updates to Add-on Without Base Rule

BCBSTX recognizes that sometimes unique circumstances require special consideration. As such, some codes are being updated within the “Add-on without Base Rule.”

Reminder

• Coding Opportunities Available Using CERA On Availity^®

Reminders

• Select Specialty Medications Transitioning to Accredo^® Specialty Pharmacy
• New AllianceRx Walgreens Prime E-Prescribing Changes

Keep Your Information Updated to Receive Quick and Accurate Payments

To provide the best service to you and your patients, it's very important that all the information BCBSTX has about your practice is current and accurate. Be sure to let us know about any changes to your practice address, email and/or physician rosters. Keeping us informed of any changes to your information helps us pay your claims more quickly and accurately. It also makes it easier for your patients to get current and correct information on Provider Finder. Please update your information by completing the Demographic Change form. Note: Changes may take up to 30 business days to complete. Please consider the impact of your change(s) and the timeliness of your submissions.

Reminder

• Watch for New CVO Details to Reduce Credentialing Burdens

Blue Promise^SM Video: Combating the Opioid Epidemic (Part I)

Policymakers attempted to combat the opioid epidemic by placing stringent regulations on prescribing and dispensing of opioids. How well did those rules work? A new study using BCBSTX data examined the regulations, and we have the authors here to discuss the results. Leanne Metcalfe, PhD, Executive Director of Planning and Research, Phiyen Tra, PharmD, Director of Clinical Programs, and co-host Ross Blackstone, Director of Strategic Influence, join Dr. McCoy for the latest video.

Making the Health Care System Work^SM Spotlight: Recent Highlights

Read the highlights of three recent health care articles, including topics about health equity, the warning signs of suicide and the role of pharmacy benefit managers.

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