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Blue Review

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

July 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

COVID-19 Coverage Updates for Medicare Providers

As the COVID-19 crisis continues to evolve, we are making changes to serve our Medicare members. You can find updates in our COVID-19 FAQs for Medicare ProvidersAdobe Acrobat Icon, which includes testing, treatment, telehealth and claims.

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Donated Remdesivir Ineligible for Separate Reimbursement

The federal government is distributing remdesivir to facilities at no charge; the donation is part of a federal program to assess the drug’s effectiveness in treating hospitalized COVID-19 patients. Currently, remdesivir is considered experimental, investigational and unproven for the treatment of COVID-19 and therefore is not reimbursable from BCBSTX.

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Behavioral Health

Behavioral Health Program Changes Reminder

Since June 1, we have been administering behavioral health benefits for the Blue EssentialsSM and Blue PremierSM provider networks. Beginning Sept 1, we will also manage behavioral health services for Health Select of Texas® and Consumer Directed HealthSelectSM.

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

Review drug list changes, updates and revisions that go into effect July 1.Adobe Acrobat Icon

Claims & Eligibility

CMS Payment Adjustments for Medicare Providers

CMS has adjusted certain payments to Medicare providers.

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Claims for Medications with Outer Packaging

When submitting medication claims that come with outer packaging, be sure to use the NDI on that packaging and not the individual vial.

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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 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:

Prior Authorization Information

Procedure Code Updates for Prior Authorization

On Sept. 1, 2020, we will update our list of Current Procedural Terminology (CPT®) codes to comply with changes from the American Medical Association (AMA). Review what you should do, and which plans are affected.

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Blue Cross Medicare AdvantageSM Prior Authorization Updates

On Sept. 1, 2020, we will update our list of Blue Cross Medicare Advantage Prior Authorization Procedure Codes to comply with the AMA. Learn what’s new.

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AIM Specialty Health® (AIM) to Perform Utilization Management

On Sept. 1, 2020, we will begin using AIM Specialty Health to process prior authorization and post-review support for some members on our Blue Choice PPOSM and Blue Essentials networks.

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Clinical Resources

Importance of a Great Discharge Summary

Learn how to improve the discharge process. Discharge summaries are a valuable resource that can improve patient outcomes by allowing continuity of care and a safe transition to other care settings and providers.

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Education & Reference

Resources for Providers/Members

Use the Resources for Providers/Members flierAdobe Acrobat Icon for information about the member resources below. You can also find the flier on the Provider Tools page.

  • Telemedicine/Telehealth
  • Language line
  • Crisis line
  • 24/7 Nurseline

Network Participation


Health & Wellness


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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