September 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)

New Online Case and Credentialing Status Checkers

Good news: you can now check the status of your submitted Provider Onboarding and/or Demographic Change forms online. You can also check the status of emails submitted to our Network Management offices.

MyBlue Health^SM Network Update

Review the ins and outs of MyBlue Health — the new HMO network starting Jan. 1, 2020, for members in Dallas and Harris counties.

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

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.

Reimbursement for Failed Neulasta^® Onpro^® Devices

The Neulasta Onpro device allows chemotherapy patients to self-administer the Neulasta drug at home. Please remember, however, that a device is not reimbursable if it fails. Only administered drugs along with appropriately related wastage are eligible for billing to BCBSTX.

Respond Electronically to Medical Record Requests for Claims

We are excited to offer more payer-provider solutions within your daily Availity^® workflow. Coming soon, you will be able to use an online Medical Attachments Application to respond to BCBSTX medical record requests related to claims processing.

Medicare Advantage Updates to Provider Finder^® Coming in September 2019

Beginning this month, Blue Cross Medicare Advantage members will have access to an enhanced online Provider Finder tool, which will have a streamlined menu and filter options.

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

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

Exciting New Functionality Coming to the Claim Research Tool (CRT^®)

Make your life easier by using the new CRT enhancements via the Availity Provider Portal. Effective Aug. 26, out-of-network line level detail is available. Effective Sept. 23, Cotiviti, Inc. (formerly known as Verscend) Rationale and Additional Action(s) will also be available.

IVR Phone System Enhancement

Starting Aug. 26, 2019, the Interactive Voice Response (IVR) phone system was enhanced to consolidate benefit responses for services that have the same benefit details. An example is provided in the article. This IVR enhancement will improve provider efficiencies and ultimately reduce your call time.

Automated Phone System Offers More Service Options for Medicare Advantage

Medicare Advantage members and their health care providers now have access to a new IVR automated phone system. Menu options include: checking eligibility and benefits, claim status, transferring to customer service for prior authorization, confirming key address and fax numbers.

Clinical Payment and Coding Policy Updates

BCBSTX publishes Clinical Payment and Coding policies on our website. The policies describe payment rules and methodologies for CPT^®, HCPCS and ICD-10 coding when applied to claims submitted as covered services. This information is offered as a resource for BCBSTX 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:

Revised effective Oct. 25, 2019:

• Chiropractic Services
• Revenue Codes Requiring CPT or HCPCS Codes
• Wasted/Discarded Drugs and Biologicals Guideline

New effective Nov. 1, 2019:

• Pneumatic Compression Devices — Outpatient Use

Reminders

• Reporting On-Demand Application Now Available for Medicare Advantage via Availity Provider Portal
• Availity Claim Research Tool Offers Enhanced Claim Status Results

Reminders

• Reminder: Verify Procedure Code Preauthorization Requirements Online
• UT Select Member Preauthorization Changes Effective Sept. 1
• Removal of Prior Authorization Requirements for Blue Cross Medicare Advantage Patients
• Notice of Change to Preservice Appeals Process for your Blue Cross Medicare Advantage^SM Patients
• New Genetic Testing and Revised Sleep Study Preauthorization Requirements for H-E-B Partners with Blue Choice PPO^SM
• City of Austin Member Preauthorization Changes

Reminders

• BCBSTX HEDIS Tip Sheet for Adult BMI Assessment
• intelliPath^SM Electronic Prior Authorization through eviCore^®

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

Well-Child Visits Within the First 15 Months of Life

HEDIS measures quality of care for all patients. One of the measures focuses on well-child visits for infants and children within the first 15 months of life (W15). Review the ages for well-child visits recommended by the American Academy of Pediatrics’ Bright Futures Periodicity Schedule. Also, you can review a chart of commonly used routine office visit codes for W15.

Celebrate September! More Fruits & Veggies Matters Month

Many know the importance of eating a healthy diet, complete with plenty of fruits and vegetables. In reality, most of us simply do not follow what we know. Help a child or teen improve their diet with documented screening and nutrition counseling during office visits.

Reminders

• 2018 In-home Colorectal Cancer Screening Testing Quality Improvement Initiative
• In-Home Colorectal Cancer Screening Test Provided to Select Members

Reminder

• Clarification: Updates to Behavioral Health Claim Review Process

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an Independent Licensee of the Blue Cross and Blue Shield Association

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