Diabetes classes available for members.  |  view in Web Browser


Blue Review

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

April 2019


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 writing functional therapy goals, decision-making aids for depression medication, measles support from the CDC, and more.

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Notices & Announcements

Three-character Prefix on Member ID Cards

As a reminder, since April 2018, BCBSTX ID numbers are alphanumeric. Review some quick reminders about our ID prefixes.

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Transferring Hospital DRG Rate Calculation and Discharge Status Code Addition

Effective July 15, BCBSTX will implement system logic to include discharge status code 05 to appropriately apply the Diagnosis Related Group (DRG) per diem calculation.

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Living365® Diabetes Classes for Members

At BCBSTX, we believe healthy actions add up. Encourage your patients who are BCBSTX members to attend diabetes education classes at participating Albertsons®, Randalls® or Tom Thumb® grocery stores. Locations, dates and a registration page are included in this article.

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Quality Improvement Program (QIP) Information Available to Providers

Learn about BCBSTX’s QIP, which promotes safe and appropriate care for members. It includes many activities that develop, review and monitor services provided, including provider satisfaction, and more.

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Network Participation

BCBSTX Plans and Referral Requirements

Get to know BCBSTX’s PPO and HMO plans and their requirements.

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Provider Onboarding Form User Guide Now Available

BCBSTX has made applying for a provider record number ID and joining our networks faster and easier than ever before. The Provider Onboarding form is now electronic and allows providers to request contracts for networks they’d like to participate in. A Provider Onboarding user guide is now available to help you apply easily.

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Pharmacy Program Updates: Quarterly Pharmacy Changes

Review pharmacy drug list changes and updates, dispensing limit changes, and Utilization Management program changes that went into effect April 1.

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Clinical Resources

Are You Using Shared Decision-making Aids?

Access a list of evidence-based shared decision-making aids that provide information about treatment options, lifestyle changes and outcomes for a wide variety of conditions. Engaging your patients in decision making can lead to better outcomes and quality of life.

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eviCore® Preauthorization Requirements

Preauthorization requirements for certain specialized services and products are required. Review the importance of using eviCore and how to access authorizations through their website.

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Claims & Eligibility

Check Eligibility and Benefits: Don’t Skip This Important First Step!

Benefits vary based on services rendered, and individual and group policy elections. It’s imperative to check eligibility and benefits for each patient before every scheduled appointment. Online options are available.

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New Clinical Payment and Coding Policy Updates

Clinical payment and coding policies have been updated or added for applied behavior analysis for autism spectrum disorders, increased procedural services (modifier 22), global surgical package, hernia repair and multiple surgery procedures.

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Notification of Annual Benefit Updates

BCBSTX is continuing to update member files with annual benefit changes. As always, we encourage you to verify your patients’ coverage first using AvailityAdobe Acrobat Icon or your preferred vendor portal. In the event you are asked to contact BCBSTX’s provider customer service, hold times may be longer than normal due to open enrollment season. For patients who are not scheduled for appointments, plan to defer eligibility and benefit information requests to a later date.

Preauthorization Information

Replacement Codes Updated on ERS Specialty Drug List

The Employees Retirement System of Texas (ERS) Specialty Drug Prior Authorization List has been updated to reflect the new replacement HCPCS codes.

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Behavioral Health


Education & Reference

Attend Free Provider Training Webinars

Whether new to these resources or if you need a refresher, there are many webinars available at no charge to learn about Availity, eviCoreTM, iExchange® and the remittance viewer.

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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.


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an Independent Licensee of the Blue Cross and Blue Shield Association

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