COVID-19 Provider Preparedness Updates | view in Web Browser
A newsletter for physician, professional, facility, ancillary and Medicaid providers |
September 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
- Assessing Child Maladaptive Behaviors: Attention-Deficit/Hyperactivity Disorder (ADHD), Other Mental Disorders, and Childhood Adversity
- ICD-10 Z Codes for Social Determinants of Health
- How to Submit a Complaint as a Medicaid Provider
- Tips to Ace THSteps, CHIP and HEDIS® Audits
- Wage Increase for Attendants
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.
| Read More |
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.
| Read More |
Reminders:
Claims & Eligibility
Submit Predetermination Requests Online via Availity®
Review the new predetermination of benefits Attachments Tool that makes the process faster and easier.
| Read More |
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.
| Read More |
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.
| Read More |
Medicare Corrected Claims
Learn how to submit corrected claims for services provided to a Medicare primary member.
| Read More |
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.
| Read More |
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
Reminder:
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.
| Read More |
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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Read More
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Medicare Advantage Plans
Reminders:
Pharmacy
Reminder:
Prior Authorization Information
Reminders:
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.com
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