December 2019

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:

• How Providers Can Improve Patient Satisfaction Scores
• Texas Department of State Health Services Laboratory Web Portal Shutdown
• Electronic Visit Verification Updates

Fee Schedule Update March 1, 2020

Effective March 1, 2020, BCBSTX will implement changes in the maximum allowable fee schedule for various networks. Learn how to access the new fee schedules and files and learn about the methodology used to develop the fee schedules for reimbursement.

2020 Blue Cross Medicare Advantage^SM Expansion Service Areas

Applies to: Blue Cross Medicare Advantage (HMO)^SM, Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)^SM
As part of our commitment to providing members access to affordable health care, we’re expanding Blue Cross Medicare Advantage across Texas. Check out the expansion areas and plan highlights.

Provider Manual Updates

As a provider, it is important you review and comply with changes made to BCBSTX’s Provider Manual. The manual is where periodic updates and clarifications to operational changes and regulatory mandates are recorded.

Behavioral Health Program Changes for AT&T Members

Beginning Jan. 1, 2020, BCBSTX will be the behavioral health benefits administrator for AT&T. Learn what this means for dates of service beginning on or after Jan. 1.

Change to Online Enrollment Process for 835 EFT & ERA through Availity^®

There are multiple advantages to enrolling in Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). To make it easier to enroll in both, a new setup tool – through Availity – will be tentatively available this month.

Availity Remittance Viewer Upgrade

Review the upgrades to the Availity Remittance Viewer Tool that will improve viewing, searching and reconciling 835 ERA. Not enrolled to receive 835 ERA files from BCBSTX? A tip sheet is available to help you enroll.

Medicare Advantage: Interpreting the ‘PLB’ Segment on the 835 ERA

Applies to: Blue Cross Medicare Advantage (HMO) and Blue Cross Medicare Advantage (PPO)
Review changes affecting the Provider Level Balance (PLB) segment within the 835 ERA. Also, we encourage you to read and share a resource document that provides details regarding adjustment codes that may appear in the PLB segment.

Medicare Advantage: Additional Payment for Medication Reconciliation Post Discharge

Performing medication reconciliation after every discharge ensures that patients understand new medications, as well as any medications that should be discontinued. Therefore, BCBSTX will reimburse contracted providers billing procedure code 1111F for conducting a medication reconciliation within 30 days of hospital discharge.

Proper Coding of Adult BMI Assessments

To help with coding, we have updated the HEDIS^® BMI Assessment Tip Sheet to help you know when to submit ICD-10 Z codes for HEDIS BMI reporting. Also, avoid common coding errors from improper use of the Z codes with additional tips.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding policies published on our website describe payment rules and methodologies for CPT^®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is offered as a resource for our payment policies; it 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 process. The following policies have been – or will be – added or updated:

• Evaluation and Management (E/M) Coding – Professional Provider – Added effective Jan. 25, 2020
• Emergency Department Services Evaluation and Management (E/M) Services Coding – Facility Services – Changes effective Jan. 25, 2020

Reminders

• Changes to Medicare Advantage Payment Models for Skilled Nursing Facility and Home Health Care Claims
• Laboratory Benefit Cost-share Change
• Review of Implant Claims from Stand-alone ACSs
• Risk Adjustment Initial Validation Audit – Important Information
• Texas House Bill 29 – Referrals for Physical Therapy
• Itemized Bills Required for BlueCard^® Claims Over $200k
• Time-based Measurement Standard to Follow AMA
• Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers Decision Memo from CMS

Medicare Advantage: Electronic Payment Summary Now Available for 835 ERA Receivers

Applies to: Blue Cross Medicare Advantage (HMO) and Blue Cross Medicare Advantage (PPO)
As of Nov. 18, 2019, 835 ERA receivers will no longer receive paper remittance advices by mail.

Medicare Advantage: New Claim Status Tool via Availity Provider Portal

Applies to: Blue Cross Medicare Advantage (HMO) and Blue Cross Medicare Advantage (PPO)
As of Oct. 31, the Availity Claim Status Tool was updated to deliver claim status results in real-time and provide more detailed information than the HIPAA-standard 277 claim status transaction.

Critical Details to Include in Hospital Discharge Summary

Studies have shown that when inpatient medical teams provide timely, structured discharge summaries to PCPs, readmission rates drop, and patient satisfaction improves. Review the information needed in all discharge summaries.

Important Pre- and Post-Natal Care Information

When you are providing pre- and post-natal care to FEP^® members, specific information needs to be included in their charts.

Antibiotic Use in Outpatient Settings

Using antibiotics when they aren’t needed can do more harm than good. Remind yourself of other remedies for conditions that typically don’t need antibiotics.

Recommendations and Reminders for Eye Care Professionals

Review the 2017 ADA position statement on diabetic retinopathy and screening recommendations for eye care specialists when providing eye exams to diabetic FEP members.

Reminders

• Congenital Syphilis Health Advisory Alert
• What You Need to Know About the 2019-2020 Flu Season
• Reminder: CMS Requires Insurers to Conduct ACA Risk Adjustment Program Audit

Pharmacy Program Updates: Quarterly Pharmacy Changes — Part 1

Review drug list changes, updates and revisions that go into effect Jan. 1, 2020.

New Programs Help Members Lead Healthier Lives

Review our Wellbeing Management and Health Advocacy Solutions programs so you can recommend them to your patients who have these benefits and could use the services. These include patients managing diabetes, obesity, substance abuse and/or depression.

Be Covered — Increasing Coverage for the Uninsured and Underinsured

Through the Be Covered campaign, BCBSTX is working with community partners to reach areas with the highest concentration of uninsured people. Be Covered helps Texans understand their coverage options and how to make the most of what’s available to them.

Reminders

• New Prior Authorization Requirements for Blue Cross Medicare Advantage Beginning Jan. 1, 2020
• 2020 New Prior Authorization Requirements and Introduction of MyBlue Health^SM

Reminder

• New Blue Cross Group Medicare Plan Names and ID Cards

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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