December 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 2019 preauthorization information updates, utilization management criteria, giving us your feedback on our medical policies, free training and support for cultural competence, and more.

It’s Here! Online Provider Onboarding Form for Joining BCBSTX Networks

BCBSTX has replaced the paper form used to request a provider record ID with an electronic Provider Onboarding form. Access the form and get important details about using it.

Federal Employee Program^® (FEP^®) Introduces FEP Blue Focus

Learn about the features of the new FEP Blue Focus program. It expands access to care and makes health care more affordable for federal employees.

FEP Benefits Changes for Infliximab Effective Jan. 1, 2019

Beginning Jan. 1, 2019, the autoimmune drug infliximab (brand names: Remicade^®, Inflectra^® and Renflexis^®) will be covered as a medical benefit, instead of a pharmacy benefit.

BlueCompare^SM for Physicians Program Discontinued

As of Dec. 1, 2018, the BlueCompare for Physicians program is no longer available. Provider performance designations will no longer be displayed on Provider Finder^®.

2018-2019 Preventive Care Guidelines Are Available

Access the updated BCBSTX Preventive Care and Wellness Guidelines. They include preventive care, health screenings and immunization strategies to promote effective clinical preventive care.

Reminders

• Medicare Advantage: Interpreting the ‘PLB’ Segment on the 835 Electronic Remittance Advice
• Prostate Cancer Screening Benefit Level Change
• New Preventive Service for Medicare Members at Risk for Type 2 Diabetes

Additional Details About BCBSTX Preauthorization Requirements Beginning Jan. 1, 2019

Updates to preauthorization and pre-notification benefit plan requirements are coming Jan. 1, 2019. Review a list of the care categories that may need preauthorization for various networks. Keep an eye out for future updates on these 2019 changes.

Check Procedure Code-specific Benefit Preauthorization Requirements Online

Learn about an upcoming electronic change to benefit preauthorization requirements for specific Current Procedural Terminology^® and Healthcare Common Procedure Coding System codes.

Blue Cross Medicare Advantage^SM Preauthorization List Update

Several codes were missing from the Jan. 1, 2019, preauthorization list published on Sept. 17, 2018. A revised list can be found in the Preauthorizations/Notifications/Referral Requirements section of BCBSTX’s website under the “Blue Cross Medicare Advantage (PPO^SM) and Blue Cross Medicare Advantage (HMO^SM) effective Feb. 1, 2019” section. If you have any questions, please contact your BCBSTX Network Management Representative.

Reminders

• Inpatient Services Require Preauthorization
• Correction to the HealthSelect^SM Sleep DME Preauthorization Procedure Codes List
• Update to the HealthSelect Prior Authorization List for Cologuard Screening through eviCore^®

Updates to Clinical Payment and Coding Policies

Review recently updated clinical payment and coding policies that went into effect Nov. 15, and an upcoming policy change that will go into effect Feb. 15, 2019.

Proper Coding Is Crucial with ‘Annual Visit’ Campaign

BCBSTX is continuing a preventive care awareness campaign that launched in July by encouraging members with asthma to see their health care provider. This is a friendly reminder that careful medical record documentation for each patient at every visit will help claim accuracy and timely payments.

Reminders

• Changes to Prior Approval Requirements for Home-based Sleep Study for FEP Members
• The Importance of Diabetic Eye Exams
• Proper Documentation of Obstetrical Care
• The Cost of Treating Individuals with Antibiotic Resistance
• 2018 Annual HEDIS^®/QRS Reports
• Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage

Reminder

• New Provider Training Webinars

Video: Blue Promise^SM – Emergency Care (Part 2)

One of the country’s leading health care economists says freestanding emergency rooms are hurting Texas’ rural hospitals. In this edition of Blue Promise, watch Dr. Vivian Ho, a health economist at Rice University’s Baker Institute, and others discuss why.

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