October 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
• Altruista SSO Availity Tip Sheet
• Clinical Practice Guidelines and Preventive Care Guidelines 2020 Updates
• Reminder: Completion of Cultural Competency Provider Training
• How Providers Can Improve Patient Satisfaction Scores (2020 CAHPS)
• Influenza (Flu) Season 2020-2021
• Private Duty Nursing for STAR KIDS, STAR, and CHIP Members

COVID-19 Provider Preparedness Updates

As the COVID-19 crisis evolves, we’re continuing to make updates on our COVID-19 Preparedness and our COVID-19 Related News pages. Be sure to check these pages frequently for updates.

Provider Finder^® Gets an Upgrade; View Our Network of Providers for Your Patients’ Needs

Do you need help finding a specialist or facility for a consultation or procedure for a BCBSTX patient? This month, our enhanced online Provider Finder will make finding care for our members a lot easier.

Behavioral Health HEDIS^® Tip Sheets: FUA and FUM

Read the two new behavioral health tip sheets we created to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code claims appropriately.

Reminder:

• Mental Health Program Changes Reminder

Blue Distinction^® Message via the Availity^® Eligibility and Benefits Results

Providers will now get a message when submitting eligibility and benefits requests through Availity when a patient has a Blue Distinction component.

Obtain BCBSTX Patient ID Numbers Online

Learn about the new online tool that will help you find BCBSTX patient ID numbers quickly. The Patient ID Finder tool allows you to obtain patient ID numbers and group numbers by entering patient-specific data elements.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies 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:

• Multiple Surgical Procedures – Professional Provider Services – Effective 11/10/2020

Reminders:

• Learn More About TRS-ActiveCare Plans
• Submit Predetermination Requests Online via Availity^®
• iExchange^® Deactivation Aug. 17, 2020

COPD and Spirometry

Despite being the gold standard for the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD), spirometry testing is still underutilized. The National Committee for Quality Assurance recommends spirometry testing for members 40 years and older.

In-Home Test Kits for Diabetics; Monitor Diabetes Control

We are working with Home Access Health Corporation to provide in-home test kits for some of our fully insured individual members with diabetes. They are sending out two different kits to members who have not received the recommended testing to close care gaps: hemoglobin A1c test kits and microalbumin urine test kits.

Colorectal Cancer Screening at Home

We are also working with Home Access Health Corporation to provide in-home Fecal Immunochemical Test (FIT) kits at no extra charge for our at-risk members. Screening with a FIT kit may be a good option to close care gaps.

Childhood Immunization Rates Fall Amidst Pandemic Fears

After the pandemic declaration in March, office visits for immunizations among our members significantly dropped. Learn what we’re trying to do about it and what you can do to help.

COVID-19: FAQs for Medicare Providers

Our response to COVID-19 continues to evolve as we work to best serve our members and providers. Review FAQs regarding COVID-19 testing, treatment, telemedicine, pharmacy and more for Medicare Advantage members.

Telehealth Visits — Medicare Advantage

Telehealth can provide our members access to the care they need, while helping protect against the spread of viruses. Due to COVID-19, we have expanded access to telehealth at no cost-share (restrictions apply) for our Medicare Advantage members through Dec. 31, 2020.

Share Your Medication Assisted Treatment Designation

If you offer opioid addiction or withdrawal treatment, consider making this information available to our members and other providers in our Provider Finder Tool. This will help others identify you when referring their patients for medication assisted treatment (MAT) care and services.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2020 — Part 2

Review drug list changes, updates and revisions that went into effect Oct. 1.

Verify Prior Authorization Requirements via Availity

Within the Availity Provider Portal, you can easily:

• Verify Current Procedural Terminology
• Verify Healthcare Common Procedure Coding System code-specific prior authorization requirements
• Submit prior authorization requests handled by BCBSTX

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an Independent Licensee of the Blue Cross and Blue Shield Association

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