December 2020

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

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
• How Providers Can Become a COVID-19 Vaccinator
• Assessing Child Maladaptive Behaviors: Attention-Deficit/Hyperactivity Disorder (ADHD), and the Basics (Eat, Sleep, Play, Connect, Regulate)
• Healthy Texas Women Program Launches Enhanced Postpartum Care

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 FAQ and COVID-19: FAQs for Medicare Providers.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Availity Provider Portal Offerings

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

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.

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.

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:

• Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) – Effective 03/01/2021
• Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS Codes – Effective 02/10/2021
• Telemedicine and Telehealth Services – Effective 02/12/2021

Hospital Discharge Summaries Empower and Inform

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

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.

Reminder:

• New Prior Authorization Lists for Blue Cross Medicare Advantage^SM

Reminder:

• Blue High Performance Network^SM (Blue HPN^SM) to Launch in January 2021

Reminders:

• Prior Authorization Expansion to AIM
• Update to Prior Authorization Services – Jan. 1, 2021

bcbstx.com/provider

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