New Prior Authorization & Referral Submission Tool via Availity  |  view in Web Browser


Blue Review

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

March 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

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.

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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 AdvantageSM 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.

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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.

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Claims & Eligibility

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.

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Three New ClaimsXtenTM 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
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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:


Prior Authorization Information

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 HealthSelectSM plans we administer.

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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. Adobe Acrobat Icon

Health & Wellness

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.

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Behavioral Health


Clinical Resources


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.

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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.

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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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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