September 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 HEDIS^® 2019 updates, electronic claim-related process improvements, National Suicide Prevention Awareness Month, how to keep the cash flowing and more.

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.

Important Reminder: Claims Will Deny if Rendering NPIs Are Not on File with BCBSTX

For claims to process correctly, it’s important that your provider record is up-to-date. Make sure it contains the following information: your National Provider Identifier (NPI); demographic information for your group and the rendering NPIs of all individual providers associated with your group.

Government Programs: Electronic Claim-related Process Improvements and Reminders

Beginning Sept. 15, BCBSTX will implement a claims processing change to stop duplicate claim rejections. This change will eliminate duplicate rejections when professional and institutional electronic claims (837P and 837I transactions) are resubmitted within 90 days of a previously submitted claim that include the exact data for the same patient and date of service.

Women’s Health Alert: Are Your Patients Getting Their Mammograms?

Early detection is key to women surviving breast cancer. BCBSTX is seeking your help to bridge the gap in mammogram screenings. Learn the reasons why some of your patients may not be getting their mammogram and what you can do to help. Also access resources you can share with your patients.

Reminders

• New Preventive Service for Medicare Members at Risk for Type 2 Diabetes
• Update to the BCBSTX Predetermination Request Form
• Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
• Provider Webinars Scheduled for 2018

Appropriate Use of Opioids Program Launched Aug. 1, 2018

BCBSTX implemented the Appropriate Use of Opioids Program to promote the safe and effective use of prescription opioids. The program is for members who have prescription drug benefits through Prime Therapeutics^®. Elements of the new program follow the CDC’s safety guidelines.

In-home Colorectal Cancer Screening Test

Applies to: Blue Advantage HMO^SM and Blue Advantage Plus^SM HMO
In August, BCBSTX began sending select members Fecal Immunochemical in-home test kits. Our goal is to increase colorectal cancer screenings by providing a test that can be completed at home. Members have the option to opt-out.

Reminders

• ‘Annual Visit’ Campaign Stresses the Importance of Proper Coding
• Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage
• High-dose Influenza Vaccine Guidelines

Pharmacy Program Updates: Quarterly Pharmacy Changes

Review the pharmacy drug list updates and program changes that went into effect July 1, 2018.

Reminders

• Select Specialty Medications Transitioning to Accredo^® Specialty Pharmacy
• Prime Therapeutics and Walgreens^® Combined Specialty and Home Delivery Pharmacy Services Company Brand Launch Completed; Important E-Prescribing Changes

Update to the Blue Cross Medicare Advantage^SM Preauthorization List

On Sept. 1, 2018, BCBSTX determined there were numerous codes listed on the fee schedule that are no longer in use. A revised list has been posted to the BCBSTX provider website under the Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM section. If you have any questions, please contact your Network Management Representative.

Reminders

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

Reminders

• Electronic Replacement/Corrected Claim Submissions
• BCBSTX Implementing Two ClaimsXten^SM Updates to Add-on Without Base Rule
• Coding Opportunities Available Using CERA On Availity^®

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

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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