August 2020

Medicaid

Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

Read this month’s Medicaid news to learn about:

• COVID-19 News and Updates
• Circumcision Procedure Codes Become a Benefit for Additional Provider Types
• Meningococcal Disease Prevention Starts with Vaccination
• Vaccinate for Human Papillomavirus: Protect Children from Cancer

COVID-19 Provider Preparedness Updates

As the COVID-19 crisis evolves, we’re continuing to make updates on our COVID-19 Preparedness and our COVID-19 Related News pages. Be sure to check these pages frequently for updates.

Update: New Group – Teacher Retirement System (TRS) Training

Provider training sessions related to TRS-ActiveCare benefits, prior authorization requirements and ID cards will be held Aug. 5, 13, 19 and 26. Watch your email and the website for invites and be sure to attend a session.

Behavioral Health Measures from HEDIS^®

Two new behavioral health tip sheets are available to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code appropriately. The tip sheets include measurement requirements, medical record best practices and billing codes.

Update: Behavioral Health Program Changes for HealthSelect of Texas^® – Sept.1

Effective Sept. 1, 2020, psychological and neuropsychological testing for HealthSelect of Texas and Consumer Directed HealthSelect^SM (HealthSelect) participants will not require prior authorization. Sept. 1, 2020, HealthSelect prior authorization lists have been updated to reflect this change.

Reminder:

• Behavioral Health Program Changes Reminder

ClaimsXten^TM Rule Descriptions

The ClaimsXten Rule Descriptions have been updated to reflect additions or changes to claims edits that are effective in 2020.

Payment Updates for Contracted Providers

We updated our payment processes on Jan. 1, 2020. Since then you may have noticed changes in the number of payments you receive from us and changes to our overpayment recovery process.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding policies describe payment rules and methodologies for CPT^®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is 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 have been recently added or updated:

• Revenue Codes Requiring CPT or HCPCS Codes – Effective 07/01/2020
• Preventive Services Policy – Effective 07/01/2020 
• Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) – Effective 09/1/2020
• Hernia Repair – Effective 09/15/2020
• Home Infusion – Effective 10/10/2020
• Implant Payment and Coding Policy – Effective 10/10/2020

Remember to Use In-Network Laboratories

As a reminder, per the BCBSTX Provider Manuals section B-d – Provider Roles and Responsibilities-Lab and Radiology – contracted providers must use and refer to BCBSTX-contracted laboratories. We have established relationships with contracted lab vendors depending on members’ health plans. Should you have any questions regarding this requirement, please contact your Network Management Office.

Imaging Studies for Low Back Pain

Applies to Federal Employee Program (FEP) Members
Prescription-strength analgesics and physical therapy are the preferred conservative treatment for low-back pain. Review HEDIS guidelines related to the use of imaging studies when appropriate.

Colorectal Cancer Screening at Home

Consider screening our members, your patients, who are 50 to 75 years old for colorectal cancer. Members in Blue Advantage HMO^SM and Blue Advantage Plus^SM HMO who have not been screened may qualify for a Fecal Immunochemical Test Kit at no extra charge.

COVID-19: FAQs for Medicare Providers

Our response to COVID-19 continues to evolve as we work to best serve our members and providers. Review FAQs regarding COVID-19 testing, treatment, telemedicine, pharmacy and more for Medicare members.

COVID-19 Coverage Updates for Medicare Providers

Review more FAQs for details about coverage for testing, testing-related visits and treatment for Medicare Advantage and Medicare Supplement members.

Reminders:

• CMS Payment Adjustments for Medicare Providers
• Blue Cross Medicare Advantage^SM Prior Authorization Updates

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2020 — Part 1

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

Reminder:

• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2020 — Part 2

AIM Prior Authorization Expansion Training

Review the steps to get ready for AIM Specialty Health^® (AIM) to administer prior authorization and post-review support for some members for the following outpatient services:

• Advanced Imaging
• Cardiology
• Sleep Medicine
• Joint and Spine Surgery
• Pain Management
• Radiation Therapy Genetic Testing services

Reminder:

• Procedure Code Updates for Prior Authorization

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an Independent Licensee of the Blue Cross and Blue Shield Association

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