Updates to Clinical Payment and Coding Policies


Blue Review

A newsletter for physician, professional, facility, ancillary and Medicaid providers

July 2018


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.

Read More

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.

Read More

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.

Read More


Focus on Behavioral Health

Depression Is on the Rise and Linked with Other Chronic Conditions

Making The Health Care System WorkThe 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.

Read More


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.

Read More

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.

Read More

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.

Read More

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.

Read More

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.

Read More

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.

Read More



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.

Read More


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.

Read More

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.

Health & Wellness Tips to Share

The Connect Community provides articles, blogs and videos, and visitors can ask questions and get answers. Topics include everything from improving well-being to explaining health coverage. Spanish is available.


Did You Know?

Did You Know (formerly In Every Issue) provides an ongoing collection of articles to assist provider offices with servicing BCBSTX members. Access this month’s articles.

BCBSTX is required to provide certain notices in all published correspondence with physicians, professional providers, and facility and ancillary providers. For the latest updates, visit the News and Updates section of the BCBSTX provider website.

Printable PDF

View a printable PDF of the non-Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

Update Your Information

Do you need to update your location, phone number, email or other important details on file with BCBSTX? Use our online forms to request information changes.

Add Associates or Office Staff to Newsletter Distribution

Are there others in your office who should be receiving this newsletter? Contact your local BCBSTX Network Management Representative to have up to 10 new contacts added to our distribution list.


A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

1001 E. Lookout Drive, Richardson, TX 75082

© Copyright 2018 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy | Unsubscribe