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Blue Review

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

September 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

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.

Learn More About TRS-ActiveCare Plans

Effective Sept. 1, 2020, TRS-ActiveCare participants’ health plans use either the nationwide Blue Choice PPOSM or statewide Blue EssentialsSM provider networks. Review the different plans to ensure which participants are eligible to visit your practice.

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Behavioral Health

Mental Health Program Changes Reminder

As of Sept 1, 2020, psychological and neuropsychological testing mental health services for HealthSelect® participants no longer require prior authorization by BCBSTX medical management. The 9/1/2020 HealthSelect prior authorization lists have been updated to reflect this change.

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Claims & Eligibility

Submit Predetermination Requests Online via Availity®

Review the new predetermination of benefits Attachments Tool that makes the process faster and easier.

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iExchange® Deactivation Aug. 17, 2020

Our electronic prior authorization, referral and predetermination of benefits request tool, iExchange, deactivated Aug. 17. Going forward, all electronic prior authorization, referral and predetermination requests handled by BCBSTX should be submitted online via the Availity Provider Portal.

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Locate a Patient’s ID Number Electronically

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

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Medicare Corrected Claims

Learn how to submit corrected claims for services provided to a Medicare primary member.

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Medicare Crossover Claim Submissions

Review the ins and outs of claim submissions when Medicare is the primary payor and the claim is crossed over to BCBSTX from Medicare.

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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:


Clinical Resources

Change to HMO Outpatient Clinical Reference Lab Services

Effective Sept. 1, 2020, providers can use any in-network clinical laboratory for Blue Advantage HMOSM, Blue EssentialsSM (including TRS-ActiveCare Primary and TRS-ActiveCare Primary+ participants), Blue PremierSM and MyBlue HealthSM. There is no longer an exclusive lab for HMO plans.

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2019 In-home Colorectal Cancer Screening Quality Improvement Initiative

Review the analysis of the July 2019 colorectal cancer screening initiative that launched in 2017.

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Medicare Advantage Plans




Prior Authorization Information


Standards & Requirements

Update: Physician Efficiency, Appropriateness, and QualitySM (PEAQSM) Program

Driving quality of care: Learn about recent updates since our January introduction of our PEAQ program that will evaluate physician efficiency, appropriateness, and quality in a transparent and multidimensional way. We’ve made updates to the methodology for the PEAQ program to include news about appropriateness, vendor selection and related measures. We plan to release program results to physicians in 2021 through Availity. Physicians can register for Availity at availity.comLeaving Site Icon.

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 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 health care 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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an Independent Licensee of the Blue Cross and Blue Shield Association

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