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Blue Review

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

October 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:

  • Providers No Longer Submit EVV Claims Directly to MCOs
  • How Providers Impact Patient Satisfaction
  • HEDIS® 2020 Updates and Your Role in Impacting HEDIS Results
  • BCBSTX and Magellan Healthcare® Provider Brown Bag Series in Austin, TX
  • Electronic Visit Verification (EVV)
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Notices & Announcements

Notice of Update to Prior Authorization Procedure Code List for Blue Cross Medicare AdvantageSM

There are important updates to the Prior Authorization Procedure Code List for patients enrolled in Medicare Advantage plans offered by BCBSTX effective Jan. 1, 2020.

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CMS Notice of Change to Reimbursement System for SNF and Home Health

Review the changes made to the Centers for Medicare & Medicaid Services’ (CMS) Notice of Change to Reimbursement System for Skilled Nursing Facilities (SNF) effective Oct. 1, and Home Health effective Jan. 1, 2020.

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New Addresses for Submitting Payments for Claim Refund Requests

Beginning Oct. 1, new addresses have been established for claim refund returns for Blue Cross Medicare AdvantageSM and commercial plans.

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FEP® Blue Focus Prior Approval Reminder

The Centers for Medicare & Medicaid Services (CMS) is currently conducting their Intial Validation Audit for 2019. Your direct involvement is essential to its success. It is of utmost importance that you respond to medical record requests in a timely manner.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2019 — Part 2

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

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Claims & Eligibility

Review of Implant Claims from Stand-alone ASCs

Beginning Dec. 15, 2019, we will change the way we review claims for implants performed at free-standing ambulatory surgery centers (ASCs).

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Laboratory Benefit Cost-share Change

Beginning Jan. 1, 2020, or upon a member’s renewal date, non-preventive labs will no longer be covered at the no member cost-share level for some BCBSTX PPO and HMO members.

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Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding policies published on our website describe payment rules and methodologies for CPT®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is offered as a resource for our payment policies; it 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 process. The following policies have been recently added or updated:


Prior Authorization Information

2020 New Prior Authorization Requirements and Introduction of MyBlue HealthSM

See the prior authorization change taking place Jan. 1, 2020, for members with Blue Choice PPOSM, Blue EssentialsSM, Blue Advantage HMOSM, Blue PremierSM, and the new MyBlue Health network.

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Clinical Resources

Updates to Clinical Practice Guidelines

We adopt clinical practice guidelines as the foundation for selected Condition Management programs. Refer to the newly updated guidelines for:

  • Asthma
  • Chronic Obstructive Pulmonary Disease, and Diagnosis Management/Prevention
  • Metabolic Syndrome
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Network Participation


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


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 articlesAdobe Acrobat Icon.

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 PDFAdobe Acrobat Icon of the non-Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

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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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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

1001 E. Lookout Drive, Richardson, TX 75082

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