October 2018

Medicaid

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

Read this month’s Medicaid newsletter to learn about checking member eligibility with Availity^®, 2019 HEDIS^® Hybrid performance measures, resources to support National Depression Education and Awareness Month, how to bill BCBSTX Medicaid as a secondary payer, plus more.

Reminder: New Application Process for Joining BCBSTX Networks

Beginning Oct. 22, BCBSTX will replace paper forms and provider record ID form packets with an electronic Provider Onboarding form.

Prostate Cancer Screening Benefit Level Change

Starting Jan. 1, 2019, prostate cancer screenings will no longer be covered at the member no cost-share level. This applies to all non-grandfathered retail and group members. It does not apply to members who have Medicaid or Medicare plans.

New Lactation Consultation Designation Added to the Demographic Change Form

Let current and prospective patients know that you provide lactation support services by adding the new Lactation Consultation designation to your Provider Finder^® profile. Use the online Demographic Change form to request the update.

Prepping for the 2018-2019 Flu Season

BCBSTX is providing flu immunization updates so you can provide your patients the best possible care. Details on BCBSTX’s complete immunization schedule are available.

Medicare Marketing Guidelines

Be sure to review the new 2019 Medicare Communications and Marketing Guidelines available on the CMS website. They reflect CMS’ interpretation of the marketing requirements and related provisions of the Medicare Advantage (MA), Medicare Prescription Drug (MA-PD), Prescription Drug (PDP) and 1876 Cost Plans benefit rules. The guidelines allow organizations offering both MAs and PDPs the ability to reference one document when developing marketing materials.

Reminders

• Claims Will Deny if Rendering NPIs Are Not on File with BCBSTX
• Government Programs: Electronic Claim-related Process Improvements and Reminders
• New Preventive Service for Medicare Members at Risk for Type 2 Diabetes
• Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
• Provider Webinars Scheduled for 2018

BCBSTX Pre-authorization and Notification Changes Beginning Jan. 1, 2019

Updates to preauthorization and prenotification requirements are coming Jan. 1, 2019, to BCBSTX benefit plans. As a reminder, patient eligibility and benefits should be verified prior to every scheduled appointment. Keep an eye out for future updates reflecting the 2019 changes

Inpatient Services Require Preauthorization

As a friendly reminder, preauthorization is required for inpatient services. Obtaining this approval is the responsibility of participating providers. Services performed without benefit preauthorization may be denied in whole or in part for payment, and you may not seek any reimbursement from the member.

Correction to the HealthSelect^SM Sleep DME Preauthorization Procedure Codes List

Recently, codes E0562 and 94660 for sleep durable medical equipment (DME) were incorrectly reported as no longer requiring prior authorization through eviCore^® for HealthSelect of Texas and Consumer Directed HealthSelect^SM participants. While prior authorization is required through eviCore for these codes, patients’ prior authorization is covered under the initial authorization for a participant’s continuous positive airway pressure ventilator.

Update to the HealthSelect Prior Authorization List for Cologuard Screening through eviCore

Effective Sept. 1, 2018, the Employee Retirement System of Texas no longer requires prior authorization through eviCore for Cologuard (procedure code 81528). The code has been removed from the “Outpatient Molecular and Genomic Laboratory Management Program Prior Authorization CPT^® Code List” on the eviCore website for HealthSelect of Texas and Consumer Directed HealthSelect participants. If you have any questions, please contact your Network Management Representative.

Sept. 1 Update to the Blue Cross Medicare Advantage^SM Preauthorization List

On Sept. 1, 2018, BCBSTX determined there were numerous codes listed on the Blue Cross Medicare Advantage preauthorization list that are no longer on in use. A revised list is available and has been posted under Preauthorizations/Notifications/Referral Requirements on the BCBSTX provider website. If you have any questions, please contact your Network Management Representative.

Reminder

• May 31 Update to the Blue Cross Medicare Advantage Preauthorization List
• ERS Sleep Authorization Requirements

New Provider Training Webinars

New training sessions have been added to the webinars calendar for Availity, iExchange^® and Remittance Viewer. Provider billers, utilization areas and administrative departments will benefit from these webinars.

New Updates to Clinical Payment and Coding Policies

Review updates made to the psychological and neuropsychological testing that went into effect Aug. 1, 2018. You can also read about the updates made to the preventive services and revenue codes requiring CPT^® or Healthcare Common Procedure Coding System (HCPCS) codes going into effect Nov. 1, 2018.

Reminders

• Electronic Replacement/Corrected Claim Submissions
• BCBSTX Implementing Two ClaimsXten^TM Updates to Add-on Without Base Rule

Important Reminder: Effective Aug. 1, 2018, Medical Policy and Coverage for Amniotic Membrane and Amniotic Fluid

Consult the updated medical policy for coverage criteria for amniotic membrane and amniotic fluid (SUR704.011).

Reminders

• Appropriate Use of Opioids Program Launched Aug. 1, 2018
• In-home Colorectal Cancer Screening Test
• Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage

Reminder

• Pharmacy Program Updates: Quarterly Pharmacy Changes, Effective July 1, 2018

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

The current opioid epidemic is the deadliest drug crisis in U.S. history. In this edition of Blue Promise, we take a deeper dive into the epidemic to understand what caused it. We also talk about new research that may indicate the extent to which opioids are addictive.

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