Medicare Advantage Annual Health Assessment Incentive  |  view in Web Browser


Blue Review

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

April 2021


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 including COVID-19: Texas Provider FAQsAdobe Acrobat Icon and COVID-19: FAQs for Medicare ProvidersAdobe Acrobat Icon.

COVID-19 Initiative Interfacility Transfer Without Prior Authorization Accommodation Expired

The previous temporary change to no longer require a post-acute care facility to wait for prior authorization to transfer our members from an inpatient hospital to an in-network medically appropriate, post-acute site ended Feb. 28, 2021.

Read More

COVID-19 Vaccines and Coverage

The Food and Drug Administration awarded an Emergency Use Authorization to Janssen Pharmaceutical Companies of Johnson & Johnson® on Feb. 27, 2021. Currently, the federal government is paying for the vaccines and we are covering the administration of the vaccines as noted in the following article.

Read More

Telemedicine Expansion for 2021

Due to the ongoing national public health emergency, we are expanding the telehealth services we’ll cover through the end of 2021.

Read More

Multiple Procedure Payment Reduction Claims Review

We will be conducting post-pay claim reviews of certain diagnostic cardiovascular and ophthalmology services to ensure reimbursement adheres to our reimbursement policy.

Read More

Behavioral Health


Claims & Eligibility

Reminder: Submit EFT and ERA Enrollments via Availity®

As a reminder, starting May 3, we will offer a single access point for enrollment in Electronic Funds Transfer (835 EFT) and/or Electronic Remittance Advice (835 ERA) via the Availity Provider Portal. As of this date, faxed or mailed EFT or ERA enrollment applications – including change/cancel requests – will be returned and redirected to the electronic option.

Read More

Hospitals and Routine Services and Supplies

Routine services and supplies are generally already included by a provider in charges related to other procedures or services. As such, these items are considered non-billable for separate reimbursement. Review the guidelines that may assist hospital personnel in identifying items, supplies and services that are not separately billable.

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:

Clinical Resources

Delivering Quality Care: Cervical Cancer Screening May Save a Life

Cervical cancer is now the most preventable gynecological cancer and the only one with both screening tests and a vaccine. Talk to your patients about getting screened for cervical cancer.

Read More

Delivering Quality Care: Caring for the Colon

Colorectal cancer is the third most common cancer in the U.S. and the third leading cause of cancer deaths. Discuss the importance of colorectal cancer screenings with your patients.

Read More

Medicare Advantage Plans

Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM Annual Health Assessment Incentive

Due to COVID-19, many Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) members haven’t completed their annual health assessment (AHA). It’s important to encourage these members to set up an in-person or telehealth AHA. For every eligible AHA you complete for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) members, you’ll receive an incentive payment of $100, in addition to your contracted rate.

Read More

The CAHPS® Survey: We All Play a Role

Every year, the Centers for Medicare & Medicaid Services sends our members the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Review information about who gets the survey and when and how you can help improve member experiences.

Read MoreAdobe Acrobat Icon


Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 — Part 2

Review drug list changes, updates and revisions that go into effect April 1.Adobe Acrobat Icon

Utilization Management

Medical Necessity Review of Observation Services

As a reminder, our policy is to provide coverage for observation services when it is determined to be medically necessary based on the medical criteria and guidelines outlined in the MCG Care GuidelinesAdobe Acrobat Icon. Claims for observation services are subject to post-service review, and we may request medical records for the determination of medical necessity.

Reminder: Commercial Plan Appeals Process for 2020 eviCore® Adverse Determinations

As a reminder, for service dates on or after Jan. 1, 2021, AIM Specialty Health® is the utilization management vendor for our commercial Prior Authorization requests. Please note that for pre- and post-service adverse determinations, eviCore will continue to process peer-to-peer and appeal requests through April 30 only. After April 30, eviCore will redirect any peer-to-peer and appeal requests to us.

Read More

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.

Adobe Acrobat Icon File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at Leaving Site Icon.

Leaving Site Icon You are leaving this website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

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

© Copyright 2021 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe