October 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:

• 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)

Notice of Update to Prior Authorization Procedure Code List for Blue Cross Medicare Advantage^SM

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.

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.

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 Advantage^SM and commercial plans.

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.

Reminder

• Reminder: CMS Requires Insurers to Conduct ACA Risk Adjustment Program Audit

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.

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).

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.

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:

• Co-Surgeon/Team Surgeon Modifiers — Effective Sept. 3, 2019 
• Chiropractic Services — Effective Dec. 3, 2019  
• Note: There is a Chiropractic Services Clinical Payment and Coding policy currently posted that will be effective Oct. 25, 2019 — Dec. 2, 2019.

Reminders

• Exciting New Functionality Coming to the Claim Research Tool (CRT^®)
• IVR Phone System Enhancement
• Automated Phone System Offers More Service Options for Medicare Advantage
• Reimbursement for Failed Neulasta^® Onpro^® Devices
• Reporting On-Demand Application Now Available for Medicare Advantage via Availity^® Provider Portal
• Availity Claim Research Tool Offers Enhanced Claim Status Results

2020 New Prior Authorization Requirements and Introduction of MyBlue Health^SM

See the prior authorization change taking place Jan. 1, 2020, for members with Blue Choice PPO^SM, Blue Essentials^SM, Blue Advantage HMO^SM, Blue Premier^SM, and the new MyBlue Health network.

Reminders

• Reminder: Verify Procedure Code Preauthorization Requirements Online
• Removal of Prior Authorization Requirements for Blue Cross Medicare Advantage Patients
• Notice of Change to Preservice Appeals Process for your Blue Cross Medicare Advantage Patients

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

Reminders

• Respond Electronically to Medical Record Requests for Claims
• BCBSTX HEDIS Tip Sheet for Adult BMI Assessment

Reminders

• New Online Case and Credentialing Status Checkers
• MyBlue Health Network Update
• Medicare Advantage Updates to Provider Finder^® Coming in September 2019

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.

Reminder

• The Keys to Unlocking a Great Discharge Summary

Reminders

• Well-Child Visits Within the First 15 Months of Life
• 2018 In-home Colorectal Cancer Screening Testing Quality Improvement Initiative

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