February 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 a change to rejection notices for invalid National Drug Codes, how to appropriately resubmit corrected claims, the integration of behavioral and physical health, and more.

Leverage the Availity^® Provider Portal for Efficiencies and Cost Savings

BCBSTX offers free online training to help you and your staff learn about new and existing tools in the Availity Provider Portal. Back-to-basics webinars teach participants how to use the portal to help verify patient information and check claim status, while in-depth trainings show how to navigate more advanced tools, such as new data-sharing tools.

Collection for Annual Medical Record Data for Quality Reporting Has Begun

HEDIS^® season is upon us. A representative may contact your office between February and May about collecting medical records. Cooperation with the collection of HEDIS and QRS data is required under providers’ contractual obligations. We appreciate your time and effort to help us meet HEDIS requirements.

Reminders

• It’s Here! Online Provider Onboarding Form for Joining BCBSTX Networks
• Fast and Easy Way to Respond to Electronic Quality and Risk Adjustment Medical Record Requests via Availity
• New Availity Capability! Close HEDIS Gaps Easily through the Availity Provider Portal
• Federal Employee Program^® (FEP^®) Introduces FEP Blue Focus
• FEP Benefits Changed for Infliximab Effective Jan. 1, 2019
• Annual Reminder: Medicare Outpatient Observation Notice Requirement
• BlueCompare^SM for Physicians Program Discontinued
• 2018-2019 Preventive Care Guidelines Are Available

Behavioral Health Care Providers: We Need Your Help to Improve Access to Care

Help us connect our members with the behavioral health care they need. Complete a brief survey to update information about your practice, so we can make it available to our members who need behavioral health services.

Reminders

• Automated Phone System Now Includes Behavioral Health Services
• The Magellan^® Connection: Partnering with PCPs to Manage their Patients’ Behavioral Health Care Needs

Radiology Quality Initiative (RQI) Program Is Business as Usual

AIM Specialty Health^® (AIM) administers the RQI Program for BCBSTX’s Blue Choice PPO^SM. An RQI number must be obtained through AIM before ordering CT/CTA scans, MRI/MRA scans, nuclear cardiology studies and PET scans for most PPO members. Also, as a reminder, it is important to check eligibility and benefits to determine if an RQI is needed.

Get Updates to the Blue Cross Medicare Advantage^SM Preauthorization List

Several codes were missing from the Jan. 1, 2019, preauthorization list published on Sept. 17. A revised list is in the Notifications/Referral Requirements section of BCBSTX’s website under the “Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM effective Feb. 1, 2019” section. If you have any questions, please contact your BCBSTX Network Management Representative.

Reminders

• New Way to Verify Preauthorization Requirements Using Procedure Codes
• Jan. 1 Preauthorization Requirement Updates

Reminder

• Quarterly Pharmacy Program Changes

Why Doctors Review Health Insurance

Learn why experienced physicians work within BCBSTX to offer a peer-level review of certain benefit preauthorization requests and claims.

Reminder: Postoperative Care Included in the Global Surgical Reimbursement Rate

Review a list of postoperative services that should be included as part of discharge planning. Ensuring your patients are well informed on how and where to access postoperative care helps curb unnecessary costs incurred with follow up care.

Updates to Clinical Payment and Coding Policies — Preventive Services Policy

Effective Jan. 1, the Preventive Services Policy was updated. As a reminder, clinical payment and coding guidelines are meant to serve as a reference for facilities and providers.

Reminder: Notification of Annual Benefit Updates

BCBSTX will update member files with annual benefit changes over the next few weeks. 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.

Reminders

• Changes to Prior Approval Requirements for Home-based Sleep Study for FEP Members
• The Importance of Diabetic Eye Exams
• Proper Documentation of Obstetrical Care
• The Cost of Treating Individuals with Antibiotic Resistance
• 2018 Annual HEDIS^®/QRS Reports
• Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage

Attend Free Provider Training Webinars

Whether new to these resources or if you need a refresher, attend online webinars to learn about Availity, eviCore^TM, iExchange^® and the remittance viewer.

Reminder

• 2019 Holiday Schedule Reminders (for 835 and 837 transactions)

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an Independent Licensee of the Blue Cross and Blue Shield Association

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