Updates to Clinical Payment and Coding Policies
A newsletter for physician, professional, facility, ancillary and Medicaid providers |
July 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 a new postpartum depression screening benefit, the two new tools added to the mental health screening requirement, filing claims with NDCs, the year-round Zika prevention benefit and more.
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Notices & Announcements
Predetermination Request Form Update; Newest Version Required Oct. 1
Recent changes to the Predetermination Request form include the collection of drug names and dosing information, and the procedure code fields will now capture units. Beginning Oct. 1, 2018, if you do not submit electronically, you must submit your paper predeterminations using the new form.
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CMS Requires Insurers to Conduct ACA Risk Adjustment Audit
The Centers for Medicare & Medicaid Services (CMS) will be conducting another Initial Validation Audit. Your direct involvement is essential to its success. It is of utmost importance that you respond to medical record requests in a timely manner.
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Reminders
Focus on Behavioral Health
Depression Is on the Rise and Linked with Other Chronic Conditions
The number of people diagnosed with major depression has increased significantly in the U.S. A new report finds that people diagnosed with major depression are almost 30 percent less healthy on average, translating to a loss of almost 10 years of healthy life. Read this Making the Health Care System WorkTM article to review eye-opening findings from the report.
Preauthorization Information
New eviCoreTM Email Notification for Utilization Management Decisions
Review important information about upcoming changes using email notifications for all preauthorization cases that are initiated through eviCore’s web portal.
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Reminder
Clinical Resources
Preventive Services Reminder: Zero Copay for Blue Cross Medicare AdvantageSM
As a steward of good health, make sure your patients are up-to-date on their preventive services benefits. Remember, there are no copays for preventive services for Blue Cross Medicare Advantage (PPO)SM or Blue Cross Medicare Advantage (HMO)SM.
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The Keys to Unlocking a Great Discharge Summary
2017 BCBSTX provider satisfaction survey results show the need to improve discharge summaries. Because discharge summaries are the conduit for communication between inpatient and outpatient care teams, they can improve patient outcomes by providing continuity and coordination of care, and a safe transition to other care settings and providers. Also, we’re sharing results from a Mayo Clinic study that identifies the top five most important elements of a discharge summary.
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High-dose Influenza Vaccine Guidelines
Make sure your patients are receiving the correct flu vaccine based on their age. Doing so ensures your patients are getting the most effective and appropriate care.
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Cancer Prevention: The Added Value in Adolescent Immunizations
Never miss an opportunity to educate parents about the importance of the Human Papillomavirus (HPV) vaccine. Research shows that parents are more likely to vaccinate their child against HPV when the vaccine’s cancer-prevention benefits are understood.
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Claims & Eligibility
Updates to Clinical Payment and Coding Policies
Review new implementations and updates to clinical payments and coding policies that either went into effect June 1, 2018, or will on Sept. 1, 2018.
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Coding Opportunities Available Using CERA On Availity®
The Claim Encounter Reconciliation Application (CERA) through the Availity Web Portal allows providers to electronically respond to potential coding gaps and determine treatment opportunities.
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Reminders
- Modifier 25 and Modifier 59 Frequently Asked Questions
- Blue Essentials AccessSM Benefit Plan: No PCP or Referrals Needed
Pharmacy
Select Specialty Medications Transitioning to Accredo® Specialty Pharmacy
As of June 1, 2018, Accredo became BCBSTX’s preferred in-network provider of select specialty medications covered under the medical benefit. Affected patients with active prescriptions are currently being transferred from AllianceRx Walgreens Prime to Accredo. Providers with patients affected by this change will be notified via fax.
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Reminder
Network Participation
Watch for New CVO Details to Reduce Credentialing Burdens
New and currently contracted professional and facility providers will begin receiving notifications from Aperture® – a Centralized Verification Organization (CVO) – regarding credentialing events and information about the new common recredentialing date that will be assigned.
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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.
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an Independent Licensee of the Blue Cross and Blue Shield Association
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