July 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
• CPT Category II Codes Can Help Close Care Gaps 
• Amondys 45 Becomes a Benefit for Texas Medicaid and CHIP
• Protect Children from Cancer with the Human Papilloma Virus (HPV) Vaccine
• QW Modifier Required for COVID-19 Testing Procedure Code 87636
• Texas Medicaid STAR Kids Forms Available in Availity^® Portal

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.

ClaimsXten^TM Update to Procedure Codes

We will implement the second and third quarter code updates for the ClaimsXten auditing tool on or after Aug. 24. Code updates may include additions, deletions and revisions to CPT^® and HCPCS codes.

Behavioral Health Resources Added to ‘Wellness Can’t Wait’ Web Page

Now’s the time to encourage your patients to get caught up on their health screenings, including their mental health. Timely identification and treatment of coexisting medical and behavioral health conditions may lead to better health outcomes. As such, we’ve added behavioral health and other resources to our Wellness Can’t Wait: Delivering Quality Care web page, including:

• Quality improvement tip sheets (including behavioral health)
• Webinar: Depression in a Primary Care Setting (Free CME)
• June 16 at 8 a.m. CT
• Educational fliers and outreach templates

Supporting Mental Health

As you know, mental health conditions are common, affecting people of all ages. We’re encouraging providers to talk with their patients about mental health, including depression and anxiety. To monitor and improve the quality of care our members are receiving, we’re tracking two measures related to mental health:

1. Follow-up after Hospitalization for Mental Illness (FUH)
2. Follow-up after Emergency Department (ED) Visit for Mental Illness (FUM)

Update to Room Rate Notification Form

Many group and member benefits only provide for a semi-private room. The room rates on file are used to determine a patient’s cost-share when the difference between a private room and a semi-private room is the patient’s responsibility. Therefore, the information you provide regarding your room rates assists us in adjudicating claims with the correct patient cost-share. We have updated our Room Rate Notification Form . When you need to make updates to your room rates, please submit the revised form to us at least 30 days before the effective date of the change(s).

Hospitals and Routine Services and Supplies

Guidelines are available that may assist hospital personnel in identifying items, supplies and services that are not separately billable because generally, they are already included by the provider in charges related to other procedures or services.

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:

• Global Surgical Package – Effective 05/26/2021
• Laboratory Panel Billing – Effective 06/10/2021 (minor format changes from Annual Review)
• Point-of-Care Ultrasound Examination Guideline – Effective 06/10/2021 (minor format changes from Annual Review)
• CPCP023 Modifier Reference Guideline – Effective 07/15//21 (updated to clarify modifiers AS and SA)
• CPCP031 Trauma Activation – Effective 08/26/2021

The Importance of Complete Discharge Summaries

Please review our Provider Satisfaction Survey – Hospital Discharge Summary Feedback for 2020. This information is important because discharge summaries are an invaluable resource. They can provide continuity and coordination of care and a safe transition to other care settings and providers.

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates and our Wellness Can’t Wait web page.

Free ‘Vaccine Confidence’ Webinar

Now more than ever, it’s vital for health care providers to educate parents on the importance of vaccinating their children. Register today for one of two free webinars on July 21 about vaccine confidence. During the webinar, you’ll learn about:

• Possible determinants of and barriers to vaccine confidence, including examples across the lifespan and among specific groups
• Several provider and team approaches to building vaccine confidence, including recommended communication and motivational interviewing techniques

Earn CME/CEU Credit at Free Webinar on Opioid Use

Join our board-certified psychiatrists and behavioral health medical directors for a one-hour webinar on opioid use disorder. The webinar is on Wednesday, Aug. 18, and attendees will earn one continuing medical education credit or continuing education unit. The webinar will provide a high-level overview of the assessment and treatment of opioid use disorder in a primary care setting.

In-Home Test Kits for Colorectal Cancer Screening

Because of the COVID-19 pandemic, many people delayed getting appropriate care, including colorectal cancer screenings. As such, we are working with Home Access Health Corporation to provide free in-home Fecal Immunochemical Test (FIT) kits to certain Blue Advantage HMO^SM and Blue Advantage Plus^SM HMO members.

Closing Gaps in Care for Group Medicare Advantage Members

The Blue Cross and Blue Shield National Coordination of Care program is again serving Blue Cross Group Medicare Advantage (PPO)^SM (Group MA PPO) members; it was paused during the pandemic. Review important reminders about the program and your participation as a Medicare provider.

CMS Payment Adjustments for Medicare Providers

The Medicare sequester has been suspended through Dec. 31, 2021. We are suspending the 2% sequestration reduction in Medicare claims payments during this time.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2021 – Part 2

This pharmacy update includes changes/updates to the drug list and the Utilization Management program. It also includes reminders about the Split Fill program and the HDHP/HAS Preventive Drug program. And HIV pre-exposure prophylaxis (PrEP) coverage updates.

Update to AIM Prior Authorization Codes for Commercial Members

We’re updating our lists of procedure codes requiring prior authorization by AIM Specialty Health^® (AIM) for some commercial members. The changes include the removal of pain management codes that were previously reviewed by AIM and adding genetic testing codes to be reviewed by AIM.

PEAQ Program Reports Coming Soon* to Availity^®

Review a list of measured specialties and see an example of the PEAQ reports that will soon be available on Availity.

Medical Necessity Review of Observation Services

As a reminder, our policy is to provide coverage for observation services when it’s determined to be medically necessary (based on the medical criteria and guidelines as outlined in the MCG Care Guidelines). Claims for observation services are subject to a post-service review and we may request medical records to determine medical necessity.

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