June 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 Post-Traumatic Stress Disorder Awareness Month, Magellan Healthcare’s Provider Brown Bag Series, developmental surveillance and screening components, and more.

New BCBSTX Network: MyBlue Health^SM

MyBlue Health is a new network that goes into effect Jan. 1, 2020, in Dallas and Harris counties.

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.

Check Your Patients’ Behavioral Health Preauthorization Requirements

Beginning July 15, we will be improving our claims review process for behavioral health services that require preauthorization. As a reminder, checking eligibility and benefits for each member before treatment will help you confirm applicable preauthorization requirements.

Reminder

• Submit Benefit Preauthorization Requests Online for Intensive Outpatient Program and Electroconvulsive Therapy Services

New Genetic Testing and Revised Sleep Study Preauthorization Requirements for H-E-B Partners with Blue Choice PPO^SM

There are important changes to the preauthorization requirements for your BCBSTX patients who are H-E-B partners and have the Blue Choice PPO health plan.

Change to Preauthorization Requirements for Spinal Fusion Surgery Procedures to eviCore^® for American Airlines Members

Review the list of spinal fusion surgery procedures that will require preauthorization through eviCore — not BCBSTX — beginning Aug. 1, 2019.

Reminders

• Save Time by Using the eviCore Web Portal for Preauthorization Requests
• Replacement Codes Updated on ERS Specialty Drug List

BCBSTX Now Offers a Choice in Pharmacies for Specialty Medications

Accredo^® and AllianceRx Walgreens Prime are now in-network pharmacies for specialty medications covered under the medical benefit for the 2019 calendar year.

Reminder

• April 1 Pharmacy Program Updates: Quarterly Pharmacy Changes

Helping Patients Find Cost-Effective Knee/Hip Replacements

Learn how BCBSTX can help you guide your patients to the most cost-effective solutions for their individual needs, like hip and knee replacements.

Reminders

• The New Great Depression
• Imaging Studies for Low Back Pain
• Quality Improvement Program Information Available
• Are You Using Shared Decision-Making Aids?
• eviCore Preauthorization Requirements

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.

Reminders

• Change in Reject Notification for Invalid National Drug Codes Used on Electronic Medicare Advantage Claims
• Check Eligibility and Benefits: Don’t Skip This Important First Step
• Three-Character Prefix on Member ID Cards
• Transferring Hospital DRG Rate Calculation and Discharge Status Code Addition

In-Home Colorectal Cancer Screening Test Provided to Select Members

Select members who are 51 to 75 years old with no claim history of having a colorectal screening may be eligible to receive a home Fecal Immunochemical Test kit. Discuss the importance of colorectal cancer screening and healthy lifestyle choices with your patients.

Reminders

• Bringing Relief to the Urban Food Desert in the Dallas Area
• Making an Impact in Our Community
• Living365^® Diabetes Classes for Members

Reminders

• Revised Change of Ownership (CHOW) Form Now Available
• BCBSTX Plans and Referral Requirements
• Provider Onboarding Form User Guide Available

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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