Recommendations and reminders to eye care professionals  |  view in Web Browser


Blue Review

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

December 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:

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

Notices & Announcements

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.

Read More

2020 Blue Cross Medicare AdvantageSM 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.

Read More

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.

Read More

Behavioral Health

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.

Read More

Claims & Eligibility

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.

Read More

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.

Read More

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.

Read More

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.

Read MoreAdobe Acrobat Icon

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.

Read More

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


Electronic Options

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.

Read More

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.

Read More

Clinical Resources

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.

Read More

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.

Read More

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.

Read More

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.

Read More



Pharmacy Program Updates: Quarterly Pharmacy Changes — Part 1

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

Read MoreAdobe Acrobat Icon

Health & Wellness

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.

Read More

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.

Read More

Prior Authorization Information


Network Participation


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, eviCore®, iExchange® and the remittance viewer.

Read More

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 articlesAdobe Acrobat Icon.

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 PDFAdobe Acrobat Icon 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 or want to receive the Blue Review by email? Use our online form to request information changes.

Leaving Site Icon You are leaving this website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

Adobe Acrobat Icon File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at Leaving Site Icon.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

1001 E. Lookout Drive, Richardson, TX 75082

© Copyright 2019 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe