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Blue Review

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

December 2020

The December Blue Review is being redistributed because the article, “New Electronic Duplicate Claim Rejections for Commercial Claims” has been updated.


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:

Notices & Announcements

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 including COVID-19: Texas Provider FAQAdobe Acrobat Icon and COVID-19: FAQs for Medicare ProvidersAdobe Acrobat Icon.

Updates on our Prior Authorization Expansion to AIM® 

As a reminder, in October we notified you that the utilization management vendor for certain outpatient prior authorizations will transition from eviCore® to AIM Specialty Health® (AIM) effective Jan. 1, 2021. Please review key transition dates and attend an informational webinar to learn more.

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Requests for Medical Records

As a reminder, providers are required by their agreements to establish and maintain accurate medical records for members. We may occasionally request medical record documentation to determine the medical necessity for services in conjunction with our policies.

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Behavioral Health

Billing for Psychological and Neuropsychological Testing

Proper coding of specific services provided for psychological and neuropsychological testing can help expedite claim processing and support accurate claim payments. Review common Current Procedural Terminology codes for billing these testing services.

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Screening and Treatment of Depression

Proper treatment of depression has been proven to effectively reduce depressive symptoms, and decrease emergency department visits and hospitalization rates. Make sure you know all of the steps to perform a successful depression screening that will promote the best outcome for your at-risk patients.

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Depression and Diabetes

Studies show that people living with diabetes are at risk of developing several psychological conditions. Review tactics to consider when discussing mental health with your diabetes patients.

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Magellan Connection: Partnering with PCPs for Behavioral Healthcare

Magellan Healthcare® is contracted to perform behavioral health managed care functions for some of our members. Review the resources and services they provide to assist you with improving medical and behavioral outcomes for your patients.

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Magellan’s Webinar Series: Improve Patient Outcomes

Magellan Healthcare offers a series of webinars that provide recommendations and guidance on crucial HEDIS® measures such as: strategies for care transition; improvements and recommendations specific to mental health populations; and those with mental illness who could subsequently develop an acute medical disease such as diabetes. Review your webinar options and sign up today.

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Claims & Eligibility

New Electronic Duplicate Claim Rejections for Commercial Claims

The information in this article has been updated. The Read More button will take you to the new article. We apologize for any inconvenience this may cause you.

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Submit Electronic Claims via Availity® at No Cost

The Availity Provider Portal offers you a no-cost solution to submit electronic Professional and Institutional claims (ANSI 837P and 837I transactions) to us. As a reminder, electronic claim submission can accelerate the claim and reimbursement process.

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Availity Provider Portal Offerings

Review the advantages of using Availity and learn why they should be your preferred vendor for checking claims and eligibility.

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Check Multiple Patients’ Eligibility and Benefits via Availity

Providers are encouraged to check member eligibility and benefits before every scheduled appointment. The Availity Eligibility and Benefits Inquiry offers an “Add Multiple Patients” feature to check real-time eligibility and coverage details for 2 to 50 patients in the same request.

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View BCBSTX Member ID Cards via Availity

Learn how you can view, download and print our members’ medical ID cards online via Availity Eligibility and Benefit Inquiry results.

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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:

Clinical Resources

Hospital Discharge Summaries Empower and Inform

Please review important information regarding discharging Federal Employee Program® (FEP®) members after inpatient hospital stays.

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Encourage Regular Pre- and Post-Natal Care

COVID-19 should not inhibit the prenatal care, referrals and consultations that are necessary for successful pregnancies. Review what’s important to document in an FEP patient’s chart to ensure coordination and continuity of care with the patient’s providers.

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Medicare Advantage Plans


Network Participation


Prior Authorization Information


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 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 health care 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.

Update Your Information

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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an Independent Licensee of the Blue Cross and Blue Shield Association

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