May 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
• Overview of the Value-added Services for STAR, CHIP and STAR Kids
• Assessing Child Maladaptive Behaviors: Highlights of the New Clinical Practice Guidelines for ADHD

COVID-19 Blue Review Special Bulletin

Extra, extra! Did you see our special edition of Blue Review covering COVID-19 news and updates? Be sure to check it out.

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.

Alert: iExchange^® Deactivation Extended

In response to COVID-19, the iExchange deactivation planned for April 15, has been temporarily suspended to allow you additional time to convert to the Availity^® Authorizations & Referrals tool during this pandemic.

Have You Heard About the New Texas Surprise Billing Law?

What’s new: A Texas law protects health plan members who received medical care on or after Jan. 1, 2020, from surprise bills in many situations where a member doesn’t have a choice in where to get care.

Reminder:

• Telemedicine and Telehealth Coverage Expansion in Response to COVID-19

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

As a reminder, starting June 1, 2020, we will administer behavioral health (BH) benefits for Blue Essentials^SM, Blue Essentials Access^SM, Blue Premier^SM and Blue Premier Access^SM provider networks. Magellan Healthcare^® will no longer administer behavioral health benefits for these members. Also, BH services for HealthSelect of Texas and Consumer Directed HealthSelect^SM participants will transition on Sept. 1, 2020.

Reminder:

• 2019 Behavioral Health Quality Improvement Program Evaluation Executive Summary

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

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

Reminders:

• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2020 – Part 1
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2020 – Part 2

Billing for Point-of-Use Convenience Kits

You should know: Only the drug component(s) of point-of-use convenience kits will be reimbursed to providers. Why? Often, the cost of these convenience kits is more than the cost of its components when purchased one item at a time.

Check Eligibility and Benefits: Don’t Skip this Step!

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 have been recently added or updated:

• Preventive Services Policy  – Effective 4/1/2020
• Applied Behavior Analysis for Autism Spectrum Disorders – Effective 07/10/2020
• Psychological and Neuropsychological Testing  – Effective 07/10/2020
• Modifier Reference Guide – Effective 07/10/2020
• Anesthesia Clinical Payment and Coding Information  – Effective 7/20/2020
• Increased Procedural Services  – Effective 07/20/2020

Reminders:

• Clarification: New BCBSTX 837 Commercial Claim Validation Edits Effective April 1, 2020
• Three New ClaimsXten^TM Rules to be Implemented June 2020

Blue Cross Medicare Advantage^® Orientation Training Webinar

Register today for a webinar to learn about providing the highest quality of care to our Medicare Advantage members and providing timely plan updates.

Complimentary Webinar Trainings Available

Do you have new staff or need a refresher about electronic options? If yes, we have added complimentary educational webinar sessions on the BCBSTX provider website for provider billers, utilization areas and administrative departments. Topics include Availity 101, Availity Authorizations & Referrals and Remittance Viewer. Please visit the Provider Training page on our provider website throughout the year to view available training topics and sign up for sessions.

Reminders:

• Using the Online Tool to Search for Doctors and Hospitals
• CMS Star Ratings Matter: Survey to Assess Medicare Advantage Members’ Experiences

Reminder:

• New Prior Authorization & Referral Submission Tool via Availity Provider Portal

Reminder:

• New Annual Wellness Visit Resources for Medicare Providers

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an Independent Licensee of the Blue Cross and Blue Shield Association

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