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A newsletter for physician, professional, facility, ancillary and Medicaid providers |
February 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:
- COVID-19 News and Updates
- Medicaid New HEDIS® Measure: Kidney Health Evaluation for Patients with Diabetes
- Texas Health Steps Checkups Common Errors
- Casirivimab and Imdevimab Added as Texas Medicaid Benefit
- Low Pre-Adolescent Vaccine Rates: Best Practices for Promoting Vaccines
- Low Pre-Adolescent Vaccine Rates: Best Practices for Promoting Vaccines for STAR Kids
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 Vaccines and Coverage
The federal government is working with drug companies to distribute millions of COVID-19 doses. Initially, the federal government will pay for the vaccine. BCBSTX or Self-Funded groups will cover administration of the vaccines as noted in this article.
| Read More |
Telehealth 2021
The onset of COVID-19 dictated the need for expanded telehealth coverage and confirmed the importance of telehealth in health care delivery. Review everything you need to know about our telehealth coverage in 2021.
| Read More |
Reminder:
Behavioral Health
Reminder:
Claims & Eligibility
Atrial Fibrillation and Diabetes Mellitus — Documentation and Coding Guidance
We’ve developed tips for documenting and coding Atrial Fibrillation and Diabetes Mellitus because quality documentation and accurate coding can help capture our members’ health status and promote continuity of care.
| 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:
- Preventive Services – Effective Jan. 15, 2021
- Telemedicine and Telehealth Services – Effective Feb. 12, 2021
- Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) – Effective April 1, 2021
- Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy – Effective May 5, 2021
Clinical Resources
Updates to Clinical Practice Guidelines
Review the six clinical practice guidelines (CPG) we recently updated. CPGs are the foundation of our Condition Management programs.
| Read More |
FEP® Annual Medical Record Data Collection for Quality Reporting
It’s that time of year. We’ll be working with a third-party vendor – Change Healthcare – to collect medical records for HEDIS.
| Read More |
2020-21 Preventive Care Guidelines Are Available
We have added the updated 2020-21 Preventive Care and Wellness Guidelines to our provider website. The guidelines are updated each year related to preventive care, health screenings and immunizations.
| Read More |
Medicare Advantage Plans
Medicare Adds Benefit for Members with Inherited Ovarian or Breast Cancer
CMS added a benefit in 2020 for Medicare members with germline or inherited ovarian or breast cancer. The benefit covers a laboratory diagnostic test using Next Generation Sequencing. Review what we cover for services performed on or after Jan. 27, 2020.
| Read More |
Reminder:
Network Participation
Contracting and Credentialing Mid-level Providers
Based on an upcoming ClaimsXten edit, the SA modifier will be non-reimbursable. Therefore, we encourage board-certified mid-levels who are not currently contracted with BCBSTX to do so to ensure their claims are not impacted.
| Read More |
Prior Authorization
Infusion Site of Care Drugs Prior Authorization Update
Effective Jan. 1, 14 new procedure codes were added for Infusion Site of Care to the Prior Authorization Services Lists for ASO and Fully Insured groups. The new codes help ensure reviews for medical necessity and site of administration are being conducted according to member benefit plan details.
| Read More |
Utilization Management
Reminders:
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