June 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:

• COVID-19 News and Updates
• Implementation of Outpatient Payment Policy
• Reporting Critical Incidents
• Tips to Ace THSteps, CHIP and HEDIS Audits
• Utilization Management Fax Numbers for STAR Kids, STAR and CHIP

Provider Information on COVID-19 Coverage

Get information all in one place. We appreciate the care you are providing our members during the COVID-19 pandemic. With the evolving changes, you can use the Provider Information on COVID-19 Coverage page to get the most current information.

COVID-19 Initiatives Extended into June

Extenuating circumstances. To continue serving our members during the pandemic, we have extended coverage dates for COVID-19 testing and treatment. A detailed chart is included for easy reference.

New Group – Teacher Retirement System (TRS) Effective Sept. 1, 2020

What’s new? Effective Sept. 1, we will manage benefits for the TRS ActiveCare account. TRS participants will be offered benefit plans using the statewide Blue Choice PPO^SM or Blue Essentials^SM provider networks.

Reminder:

• Have You Heard About the New Texas Surprise Billing Law?

Billing and Documentation Information Requirements Reminder

Confused about the difference between permissible, pass-through, under arrangement and all-inclusive billing? Need clarification on billing AS and SA modifiers? Review the annual notice to refresh these billing practices.

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:

• Corrected Claim Submission – Effective 8/15/2020
• Global Surgical Package – Effective 8/15/2020

Reminders:

• Billing for Point-of-Use Convenience Kits
• Three New ClaimsXten^TM Rules to be Implemented June 2020

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

Reminder:

• Blue Cross Medicare Advantage^® Orientation Training Webinar

Join ParPlan

Review the benefits of joining ParPlan. It’s a program that’s open to physicians and other providers whether contracted in our provider networks or not. The objective of ParPlan is to offer convenient, cost effective medical services to our company's subscribers.

Changes to Contacting Electronic Commerce Services

What’s new: As of June 15, 2020, providers and clearinghouses will be directed to email inquiries to Electronic Commerce Services instead of calling.

eviCore^® Prior Authorization Code Changes Effective April 20, 2020

What’s changing: We have updated our procedure code list for fully insured members based on changes made by the American Medical Association.

BlueCard^® Alert: Prime Healthcare Member Required Authorizations for Care

Did you know: Prime Healthcare is a national health system with hospitals in 14 states. When Prime Healthcare members seek treatment outside of its network of facilities, providers are required to seek authorization for post-stabilization care from Prime Healthcare Utilization Management.

In-home Colorectal Cancer Screening Test for Eligible Members

Convenience matters. Members in our Blue Advantage HMO^SM, Blue Advantage Plus^SM HMO and MyBlue Health^SM networks may be able to receive free colorectal cancer screening kits through their local Walmart pharmacy or mailed to their home.

New Annual Wellness Visit Resources for Medicare Providers

Check out two new resources to help you care for our Medicare Advantage members during their annual wellness visits. They can help you document patient visits to more easily meet Medicare requirements.

Reminder:

• Behavioral Health Program Changes for HealthSelect of Texas^® Effective Sept. 1

Reminder:

• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2020 – Part 1

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an Independent Licensee of the Blue Cross and Blue Shield Association

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