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Blue Review

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

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.

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Notices & Announcements

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.

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Network Participation

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.

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Clinical Resources

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.

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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.

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Claims & Eligibility

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.

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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).

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Preauthorization Information

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

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.

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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.

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Health & Wellness

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.

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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.

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Behavioral Health

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Pharmacy

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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.

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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? Use our online forms to request information changes.

bcbstx.com/provider

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