Medicare Advantage Annual Health Assessment Incentive | view in Web Browser
A newsletter for physician, professional, facility, ancillary and Medicaid providers |
April 2021
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:
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 FAQs
and COVID-19: FAQs for Medicare Providers.
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
Reminder:
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 |
Reminders:
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:
- Telemedicine and Telehealth Services – Effective 02/12/2021
- Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) – Updated to change the effective date for C9771 from 5/15/2021 to 07/01/2021
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.
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Pharmacy
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.
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 Guidelines
. 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.
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