May 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 Medicaid member rights and responsibilities, billing with appropriate diagnosis codes, depression not always being a major depressive disorder and more.

BCBSTX Announces New Partnership with Sanitas

BCBSTX recently announced a new partnership with Sanitas to build 10 advanced primary care medical centers in Houston and Dallas.

Revised Change of Ownership (CHOW) Form Now Available

Read about the revision to the Consent to Assignment of Provider Contracts — Change of Ownership (CHOW) form that’s used to process a change in ownership for a hospital and/or ancillary provider.

Reminders

• BCBSTX Plans and Referral Requirements
• Provider Onboarding Form User Guide Available
• Navigating Provider Finder^®

The New Great Depression

With depression diagnoses on the rise, encourage your BCBSTX patients to learn about their behavioral health benefits. They may have coverage for office visits, therapy, medication or even virtual visits with behavioral health professionals.

Imaging Studies for Low Back Pain

According to the NCQA, patients with a new onset low back pain diagnosis normally should not receive imaging within the first 30 days of diagnosis. However, there may be instances where imaging should be considered. Access an evaluation chart to use with patients presenting low back pain.

Reminders

• Quality Improvement Program Information Available to Providers
• Are You Using Shared Decision-Making Aids?
• eviCore^® Preauthorization Requirements

Clinical Payment and Coding Policy Updates

Clinical payment and coding policies will be updated or added in July 2019 for: telemedicine and telehealth services, trauma activation, and neonatal intensive care unit level-of-care authorization and reimbursement.

Change in Reject Notification for Invalid National Drug Codes (NDCs) Used on Electronic Medicare Advantage Claims

Effective April 11, 2019, payer response reports will identify invalid NDCs that are causing a claim to reject for Medicare Advantage plans. Please share the following information with your practice management/hospital information system software vendor, billing service or clearinghouse to ensure they will be able to process/display the additional data element (2200D, STC12).

Reminders

• 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
• Billing BCBSTX Members Additional Fees
• Government Programs: New Tool for Verifying Claim Status in Availity^®
• BCBSTX’s Payer Spaces Updates in Availity Provider Portal

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

Effective Aug. 1, 2019, you will have to obtain preauthorization through eviCore for an expanded list of molecular and genetic lab procedures. Also, some genetic testing and sleep study procedure codes no longer require preauthorization.

Save Time by Using the eviCore Web Portal for Preauthorization Requests

Learn how using eviCore for preauthorization requests can save you time. One example is that submitting a request through the portal will help ensure it’s submitted correctly and with all the needed information. This will help the approval process go more smoothly.

Reminder

• Replacement Codes Updated on ERS Specialty Drug List

Bringing Relief to the Urban Food Desert in the Dallas Area

If you’re a Dallas, Texas provider, familiarize yourself with “foodQ” — a subscription-based food service that will soon be delivering healthy meals to food deserts. Discuss this new option with your patients who could benefit from the service. Note: Patients do not have to be BCBSTX members to participate in foodQ.

Making an Impact in Our Community

The “Making an Impact” report tells how BCBSTX is working to improve health and wellness in our communities. Check out the report to see how we’re going deeper into our communities to improve the lives of others.

Reminder

• Living365^® Diabetes Classes for Members

Reminder

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

Reminder

• April 1 Pharmacy Program Updates: Quarterly Pharmacy Changes

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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