Two New ClaimsXten Rules to be Implemented in 2020  |  view in Web Browser


Blue Review

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

February 2020


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

New Prior Authorization & Referral Submission Tool via Availity® and Provider Portal

What’s changing: Soon you can begin using Authorizations & Referrals, our new online prior authorizations tool, which is easy to use with only five steps.

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Reminder: Fee Schedule Update March 1, 2020

Coming soon: Effective March 1, BCBSTX is changing the maximum allowable fee schedule for the following networks:

  • Blue Choice PPOSM
  • Blue EssentialsSM (including HealthSelectSM of Texas Network)
  • Blue PremierSM
  • Blue Advantage HMOSM
  • MyBlue HealthSM
  • PAR Plan
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Behavioral Health

Updates to Behavioral Health Clinical Practice Guidelines

With members in mind: The Behavioral Health Guidelines have been updated to include links to information about various Care Management programs. These programs aim to improve health outcomes for members and reduce medical care claims.

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Claims & Eligibility

Two New ClaimsXtenTM Rules to be Implemented in 2020

Making improvements. ClaimsXten software will be updated to better align coding with the reimbursement of claims. On April 20, the following two rules will be updated:

  1. Bilateral Services for Professional Claims
  2. Modifier to Procedure Validation Filter – Non-payment Modifiers
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Reminder: Medicare Beneficiary Identifier Must be Submitted on Claims

Date check. This is a reminder that Dec. 31, 2019, was the last date that claims could be submitted using the old Health Insurance Claim Numbers. Effective Jan. 1, 2020, regardless of the date of service, all claims must be submitted using the new Medicare Beneficiary Identifier number.

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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 policy was recently added:


Clinical Resources

Coordinating Care Between Behavioral Health and Medical Providers

Sharing information = improved health outcomes. A Coordination of Care form is now available for behavioral health and medical care providers to request patient information from each other. To improve patient outcomes, consulting and referring providers should share information with each other such as diagnoses, medications, treatment plans and recommendations.

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Annual Medical Record Data Collection for Quality Reporting Begins Feb. 1, 2020

Things to know: Texas state law requires HMOs in Texas to report HEDIS data to the Department of State Health Services on an annual basis. Therefore, a representative from CIOX – our contracted vendor – or BCBSTX staff may be contacting your office/facility between February and May to request information to meet the requirements.

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Prior Authorization Information

HMO Plans – PCP Selection and Referral Requirements 2020

The rundown: There are various HMO plans and those plans have different requirements for referrals and services, and the addition of information on MyBlue Health. Make sure you’re in-the-know by reviewing the criteria.

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Prior Authorization Changes for Certain BCBSIL Members in Texas

New prior authorization requirements for some Blue Cross and Blue Shield of Illinois (BCBSIL) members in Texas go into effect March 1. Know which three-character prefixes on ID cards are impacted and which services require prior authorization.

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Network Participation


Education & Reference

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 – including Availity Authorizations – eviCore and the remittance viewer.

Read More

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 (formerly In Every Issue) 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 physicians, professional providers, and facility and ancillary 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.

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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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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

1001 E. Lookout Drive, Richardson, TX 75082

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