January 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 the LTSS enrollment requirement, a new morphine dose limitation that takes effect Jan. 28, tips for submitting corrected and duplicate claims, and more.

It’s Here! Online Provider Onboarding Form for Joining BCBSTX Networks

To request a BCBSTX Provider Record ID for professional providers, please use the new electronic Provider Onboarding form. As of Jan. 1, 2019, BCBSTX no longer accepts paper forms. Learn how to access the online form and how to use it.

Fast and Easy Way to Respond to Electronic Quality and Risk Adjustment Medical Record Requests via Availity^®

Great news! Soon providers will receive electronic quality and risk adjustment medical record requests from BCBSTX via Availity. Sign up for free through the Availity Provider Portal.

New Availity Capability! Close HEDIS^® Gaps Easily through the Availity Provider Portal

To quickly comply with HEDIS measures, close quality gaps and support BCBSTX’s Centers for Medicare & Medicaid Services star rating, use Availity’s new Clinical Quality Validation tool.

Beginning Feb.1, 2019, Representatives Begin Collecting Annual Medical Record Data for Quality Reporting

HEDIS season is upon us. A representative from BCBSTX or from our contracted vendor, CIOX, may contact your office from February to May to explain how to collect 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.

Annual Reminder: Medicare Outpatient Observation Notice Requirement

As a reminder, hospitals and critical access hospitals must give the standardized Medicare Outpatient Observation Notice (MOON) to people who receive Medicare and are observed as outpatients for more than 24 hours.

Reminders

• Federal Employee Program^® (FEP^®) Introduces FEP Blue Focus
• FEP Benefits Changed for Infliximab Effective Jan. 1, 2019
• BlueCompare^SM for Physicians Program Discontinued
• 2018-2019 Preventive Care Guidelines Are Available
• Medicare Advantage: Interpreting the ‘PLB’ Segment on the 835 Electronic Remittance Advice

Automated Phone System Now Includes Behavioral Health Services

As of Dec. 16, if a call is made to BCBSTX to verify patient coverage for behavioral health services, providers must first collect eligibility and benefit details through the Interactive Voice Response phone system.

The Magellan^® Connection: Partnering with PCPs to Manage their Patients’ Behavioral Health Care Needs

Resources and services are available to you though Magellan Healthcare, which can enhance medical and behavioral outcomes for your patients.

Quarterly Pharmacy Program Changes

Review drug list changes including Utilization Management Program changes and information about the new Hemophilia Factor VIII, IX PA Program, which all went into effect Oct. 1.

New Way to Verify Preauthorization Requirements Using Procedure Codes

Since Dec. 10, providers can view preauthorization requirements by Current Procedural Terminology^® and Healthcare Common Procedure Coding System codes through the Availity Provider Portal. Attend our complimentary webinars to see how it works!

Jan. 1 Preauthorization Requirement Updates

Updates to preauthorization and pre-notification benefit plan requirements began Jan. 1, 2019. Review a list of the care categories that may need preauthorization for various networks. Be aware of future updates on 2019 changes.

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.

Reminder

• Inpatient Services Require Preauthorization

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.

New Clinical Payment and Coding Policy Updates

Clinical payment and coding policy updates are made periodically and posted to the BCBSTX provider website. Effective April 1, 2019, policy updates will go into effect for drug testing clinical payment and coding, modifier reference guides and medical record documentation guidelines.

Reminder

• Proper Coding Is Crucial with ‘Annual Visit’ Campaign

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

2019 Holiday Schedule Reminders

Review the 2019 holiday schedule to plan for scheduling issues that may affect electronic claims (837), and/or claim payments, and remittance (835) transactions in 2019.

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