March 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:

• Medicaid Members Now Have Access to Mail-order Pharmacy
• THSteps, Bright Futures and HEDIS^® requirements help your patients stay healthy

Thanks for Responding to the HHS-RADV Initial Validation Audit

A warm thank you to everyone who contributed to the successful 2019 Health and Human Services Risk Adjustment Data Validation (HHS-RADV) Initial Validation Audit season.

CMS Star Ratings Matter: Survey to Assess Medicare Advantage Members’ Experiences

Let’s improve together. Please encourage your patients to respond if they receive the CAHPS^® survey. It will be sent to members enrolled in our Blue Cross Medicare Advantage^SM and/or prescription drug plans. It evaluates how our members interact with their health plan and you – their provider. It also identifies opportunities to improve member satisfaction.

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

What’s new: You can begin using Availity Authorizations & Referrals – the new online prior authorizations tool through Availity, which is easy to use with only five steps.

New BCBSTX 837 Commercial Claim Validation Edits

What’s happening: Beginning April 1, we will implement new electronic claim submission validation edits for commercial professional and institutional claims (837P and 837I transactions). Learn what this means and what you should do.

Three New ClaimsXten^TM Rules to be Implemented June 2020

New rules. Review details about updates to the following rules in the ClaimsXten software database:

1. Revenue Codes Requiring Healthcare Common Procedure Coding System (HCPCS) Code
2. Lifetime Event
3. Multiple Medical Same Day Visits

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:

• Drug Testing Clinical Payment and Coding Policy.

Reminders:

• Reminder: Medicare Beneficiary Identifier Must be Submitted on Claims
• Two New ClaimsXten Rules to be Implemented in 2020
• Reminder: Fee Schedule Update March 1, 2020
• Medicare Providers May Not Bill Participants in the Qualified Medicare Beneficiary Program
• National Coordination of Care^SM Program for Group Medicare Advantage PPO Members
• Reminder of Change to the Pre-service Appeals Process for Your Blue Cross Medicare Advantage Patients

Change to Prior Authorizations for HealthSelect of Texas^® Effective March 1, 2020

Learn more: Since March 1, we are managing prior authorizations previously managed by eviCore^® for the HealthSelect of Texas and Consumer Directed HealthSelect^SM plans we administer.

Reminders:

• HMO Plans – PCP Selection and Referral Requirements 2020
• Prior Authorization Changes for Certain BCBSIL Members in Texas

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

Review drug list changes, updates and revisions that go into effect April 1.

Get the Conversation Started on Colorectal Cancer

A conversation starter. Colorectal cancer is preventable, treatable and beatable! March is Colon Cancer Awareness month – use it as a prompt to talk with your patients about it.

Reminder:

• Updates to Behavioral Health Clinical Practice Guidelines

Reminders:

• Coordinating Care Between Behavioral Health and Medical Providers
• Annual Medical Record Data Collection for Quality Reporting Begins Feb. 1, 2020
• Reminder Medicare Advantage Program 30-Day Readmission Facility

Reminder:

• Physician Efficiency, Appropriateness and Quality (PEAQ) Program Measuring and Maximization

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.

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