Reminder: Postoperative Care Is Included in the Global Surgical Reimbursement Rate  |  view in Web Browser


Blue Review

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

February 2019


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.

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Notices & Announcements

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.

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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.

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Behavioral Health

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.

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Preauthorization Information

Radiology Quality Initiative (RQI) Program Is Business as Usual

AIM Specialty Health® (AIM) administers the RQI Program for BCBSTX’s Blue Choice PPOSM. 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.

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Get Updates to the Blue Cross Medicare AdvantageSM 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.




Claims & Eligibility

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.

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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.

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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.

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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.

Clinical Resources


Education & Reference

Attend Free Provider Training Webinars

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

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Health & Wellness

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.

Update Your Information

Do you need to update your location, phone number, email or other important details on file with BCBSTX? Use our online forms to request information changes.

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an Independent Licensee of the Blue Cross and Blue Shield Association

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