April 2019

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

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.

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.

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.

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.

BCBSTX Plans and Referral Requirements

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

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.

Reminder

• Navigating Provider Finder^®

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.

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.

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.

Reminders

• Annual Medical Record Data Collection for Quality Reporting Began Feb. 1
• Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage^SM

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.

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.

Reminders

• Billing BCBSTX Members Additional Fees
• Government Programs: New Tool for Verifying Claim Status in Availity^®
• BCBSTX’s Payer Spaces Updates in Availity Provider Portal
• Leverage the Availity Provider Portal for Efficiencies and Cost Savings
• Reminder for Physicians: Postoperative Care Included in the Global Surgical Reimbursement Rate

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 Availity 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.

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.

Reminders

• Radiology Quality Initiative Program Is Business as Usual
• Checking Preauthorization Requirements by Procedure Code on Availity

Reminder

• Submit Benefit Preauthorization Requests Online for Intensive Outpatient Program and Electroconvulsive Therapy Services

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, eviCore^TM, iExchange^® and the remittance viewer.

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