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Blue Review

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

July 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 the:

  • Reporting On-Demand app via the Availity® Provider Portal
  • In-person behavioral health discussion series
  • Coordination of care between providers across all care settings
  • Catch-up immunization schedule for kids
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Notices & Announcements

Network Participation Page Revisions are Here

BCBSTX has enhanced the provider onboarding process to help you obtain a provider record ID and get contracted more efficiently.

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Behavioral Health

Clarification: Updates to Behavioral Health Claim Review Process

In August, BCBSTX will be updating its internal review process for behavioral health claims that require benefit preauthorization. The specific services requiring benefit preauthorization and the process for submitting benefit preauthorization requests are not changing.

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Preauthorization Information

City of Austin Member Preauthorization Changes

Review the changes to the preauthorization requirements for your patients who are City of Austin members with one of the following employer group numbers on their BCBSTX identification cards: 246681, 246682, 246683 or 246684.

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Changes to Specialty Drugs Preauthorization List: Always Check Preauthorization Requirements

Review the two codes that have changed on the Specialty Pharmacy Infusion Site of Care Preauthorization Drug List.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2019

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

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Clinical Resources

While ADHD Diagnosis Rises, Treatment Patterns Fall Short

A BCBSA study of kids with Attention-Deficit/Hyperactivity Disorder (ADHD) showed a large gap in treatment from what the American Academy of Pediatrics recommends and actual practice. Review statistics from that report and learn what you can do to help your pediatric patients with ADHD.

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Claims & Eligibility

Clinical Payment and Coding Policy Updates

BCBSTX publishes Clinical Payment and Coding policies on our website that describe payment rules and methodologies for Current Procedural Terminology (CPT®), HCPCS and ICD-10 coding when applied to claims submitted as covered services. This information is offered as a resource regarding BCBSTX payment polices and 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 processes.


Network Participation


Health & Wellness


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.

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

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