Removal of Prior Authorization Requirements for BCBSTX Medicare Advantage Patients  |  view in Web Browser


Blue Review

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

August 2019


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:

  • Billing BCBSTX Medicaid as a Secondary Payer
  • Well-Child HEDIS® Update and Documentation Changes 
  • Improving Care for Patients with Attention Deficit Hyperactivity Disorder
  • Mental Health Provider Brown Bag Series in Austin
  • Electronic Visit Verification
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Notices & Announcements

Member Letters Have a New, Simpler Look

BCBSTX knows your time is valuable. To make our member letters (that you receive copies of) more straightforward and simple, we have a fresh, updated look eliminating nonessential information. Best of all, the new layout is now in color and includes symbols that are easy to understand. The changes are designed to make it almost effortless to locate answers for the most common questions about the services your patients received. Both you and your patients can find the information you need fast. As always, you will be copied on member letters related to service request approvals and denials. Keep a lookout for the redesigned letters.

Preauthorization Information

Update: New Genetic Testing and Revised Sleep Study Preauthorization Requirements for H-E-B Partners with Blue Choice PPOSM

The preauthorization requirements for your BCBSTX patients who are H-E-B partners has been delayed to Aug. 31, 2019. In addition, review corrections made to three codes on the “H-E-B Members Only Additional Preauthorization Procedure Code List Effective 8/31/2019.”

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Notice of Change to Preservice Appeals Process for your Blue Cross Medicare AdvantageSM Patients

Review the important changes to the preservice appeals process for patients enrolled in Medicare Advantage plans offered by BCBSTX.

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Removal of Prior Authorization Requirements for Blue Cross Medicare Advantage Patients

Beginning Sept. 1, 2019, prior authorization from eviCore® will no longer be required for cardiology or specialty therapy.

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UT Select Member Preauthorization Changes Effective Sept. 1

Beginning Sept. 1, 2019, providers will need to obtain preauthorization for an expanded list of select specialized services and procedures through eviCore for UT SELECT BCBSTX members.

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Reminder: Verify Procedure Code Preauthorization Requirements Online

A tip sheet is available to help you successfully verify preauthorization requirements for specific Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes via an eligibility and benefits inquiry in the Availity® Provider Portal.

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Clinical Resources

eviCore Preauthorization Training — Obstetrical Ultrasounds

A simple error can lead to a denial, so learn how to properly submit requests for Obstetrical Ultrasounds by enrolling in an eviCore training session. The first training is Tuesday, Aug. 6. The training is free, but registration is required.

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BCBSTX HEDIS Tip Sheet for Adult BMI Assessment (ABA)

Use the Healthcare Effectiveness Data and Information Set (HEDIS) ABA tip sheet with specific ICD-10 Z codes and charting tips to help you measure and document your patients’ BMI.

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intelliPathSM Electronic Prior Authorization (ePA) through eviCore

If your practice utilizes an Electronic Health Record, intelliPath ePA allows you to automate your preauthorization processes at no cost.

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Claims & Eligibility

Reporting On-Demand Application Now Available for Medicare Advantage via Availity® Provider Portal

In addition to accessing commercial PPO and HMO Provider Claim Summaries using Availity’s Reporting On-Demand feature, providers can also now use it for Medicare Advantage claims. This online application allows you to get claim results for multiple patients in one central location.

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Availity Claim Research Tool (CRT) Offers Enhanced Claim Status Results

Save yourself time and frustration by using Availity’s CRT. It’s one of the most convenient, efficient and secure methods of requesting detailed claim status information from BCBSTX.

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Clinical Payment and Coding Policy Updates

BCBSTX publishes Clinical Payment and Coding policies on our website that describe payment rules and methodologies for Current Procedural Terminology (CPT®), HCPCS and ICD-10 coding when applied to claims submitted as covered services. This information is offered as a resource regarding BCBSTX payment policies and is not intended to address all reimbursement related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review processes.

Education & Reference

The Keys to Unlocking a Great Discharge Summary

Communications between hospitals and PCPs are critical for a smooth and long-lasting transition of patients to the next level of care. Continuity and coordination of care may avoid miscommunication or delays in care that may lead to poor outcomes.

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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, iExchange® and the remittance viewer.

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Health & Wellness

2018 In-home Colorectal Cancer Screening Testing Quality Improvement Initiative

Results from the 2018 colorectal cancer test initiative are in. While there has been steady improvement since the initiative began in 2017, more can be done. Learn what you can do to encourage your patients who receive the test kits to participate.

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Network Participation


Behavioral Health


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.

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Do you need to update your location, phone number, email or other important details on file with BCBSTX or want to receive the Blue Review by email? Use our online form to request information changes.

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