COVID-19 Coverage Updates for Medicare Providers | view in Web Browser
A newsletter for physician, professional, facility, ancillary and Medicaid providers |
July 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:
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 Providers
, 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.
| Read More |
Reminders:
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.
| Read More |
Pharmacy
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.
Claims & Eligibility
CMS Payment Adjustments for Medicare Providers
CMS has adjusted certain payments to Medicare providers.
| Read More |
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.
| Read More |
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:
- Hernia Repair – Updated Effective 9/15/2020
- Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy – Updated Effective 6/15/2020
- Observation Services Tool for Applying MCG Care Guidelines – Updated Effective 6/15/2020
- Point-of-Care Ultrasound Examination Guideline – Added Effective 9/15/2020
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.
| Read More |
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.
| Read More |
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.
| Read More |
Reminder:
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.
| Read More |
Education & Reference
Resources for Providers/Members
Use the Resources for Providers/Members flier 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
Reminder:
Health & Wellness
Reminder:
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