July 2019

Medicaid

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

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.

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.

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.

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.

Reminders

• New Genetic Testing and Revised Sleep Study Preauthorization Requirements for H-E-B Partners with Blue Choice PPO^SM
• Change to Preauthorization Requirements for Spinal Fusion Surgery Procedures to eviCore for American Airlines Members

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

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

Reminder

• BCBSTX Now Offers a Choice in Pharmacies for Specialty Medications

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.

Reminders

• Helping Patients Find Cost-Effective Knee/Hip Replacements
• Imaging Studies for Low Back Pain

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.

Reminder

• Change in Reject Notification for Invalid National Drug Codes Used on Electronic Medicare Advantage Claims

Reminder

• New BCBSTX Network: MyBlue Health^SM

Reminders

• In-Home Colorectal Cancer Screening Test Provided to Select Members
• Bringing Relief to the Urban Food Desert in the Dallas Area

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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