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A newsletter for physician, professional, facility, ancillary and Medicaid providers |
February 2022
MEDICAID
Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers
Our Medicaid (STAR, CHIP and STAR Kids) provider website has a new streamlined design to enhance your online experience and help you find information easier. The change will not affect resources that have already been available to you. However, one change is the relocation of Utilization Management (Prior Authorization) to Claims and Eligibility (from Clinical Resources). All other information will remain where it’s currently located.
Read this month’s Medicaid news to also learn about:
NOTICES & ANNOUNCEMENTS
COVID-19 Provider Preparedness Updates
Check for continuing updates to our COVID-19 Preparedness, COVID-19 Provider Information for ERS Participants and COVID-19 Related News pages.
Reminder: New Look Ahead for Provider Website
Coming soon, our provider website will have a new streamlined design. We’re making changes to enhance your online experience and help you easily find the information you need. Information will be in the sections you’re used to seeing, such as Claims and Eligibility and Education and Reference. Please watch for future updates.
Verify Your Directory Details
Due to a new federal law, your directory information must be verified every 90 days. It’s easy and quick to get it done for all health plans in Provider Data Management via Availity Essentials, or if you prefer, you can use our Demographic Change Form. If we don’t receive your timely verification, look for friendly reminders with a checkmark symbol by email or postcard that’ll remind you it’s time to verify or update.
Annual Medical Record Data Collection for Quality Reporting Begins Feb. 1
To meet U.S. Department of Health and Human Services requirements, we will be collecting medical records using Change Healthcare, an independent contracted third-party vendor, as well as BCBSTX staff. If you receive a request for medical records, we encourage you to reply within 3-5 business days.
| Read More |
FEP® Annual Medical Record Data Collection for Quality Reporting – HEDIS®
To meet the annual quality reporting requirement, we will be collecting medical records using internal resources and the independent contracted third-party vendor, Episource. The retrieval process begins in February and runs through April. If you receive a request for medical records, we encourage you to reply within 5 business days.
| Read More |
ClaimsXtenTM Quarterly Update Effective April 11, 2022
We will implement our first quarter code updates for the ClaimsXten Auditing Tool on or after April 11, 2022.
| Read More |
CLAIMS & ELIGIBILITY
Clinical Payment and Coding Policy Updates
The Clinical Payment and Coding Policies on our website 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 policies have been recently added or updated:
| • | CPCP027 Inpatient Readmissions – Effective 1/1/2022 |
| • | CPCP006 Preventive Services – Effective 1/1/2022 |
| • | CPCP016 Chiropractic Care Services – Effective 1/14/2022 |
| • | CPCP002 Inpatient/Outpatient Unbundling - Facility – Effective 1/14/2022 |
| • | CPCP004 Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement – Effective 1/14/2022 |
| • | CPCP017 Wasted/Discarded Drugs and Biologicals – Effective 1/14/2022 |
| • | CPCP018 Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT, HCPCS and/or NDC Codes – Effective 3/22/2022 |
| • | CPCP022 Pneumatic Compression Devices – Outpatient Use – Effective 04/12/2022 |
| • | CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) – Effective 04/15/2022 |
Reminder:
| • | Claim Editing Enhancements Are Coming April 1 |
CLINICAL RESOURCES
Cervical and Breast Cancer Screenings
As you know, regular screenings for cervical cancer and breast cancer play an important role in women’s health. Consider using the New Year as an opportunity to remind our members to schedule their screenings since early detection sometimes makes treatment easier. Review recommended screenings, how to close gaps in care and tips to consider.
| Read More |
HEALTH & WELLNESS
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.
MEDICARE ADVANTAGE PLANS
Reminder:
| • | Blue Cross Medicare AdvantageSM Prior Authorization Code Update Effective April 1, 2022 |
PHARMACY
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 2
Review important benefit reminders, drug list changes, drug list updates and Utilization Management Program changes.
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Read More
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PRIOR AUTHORIZATION
Reminder:
| • | Prior Authorization Code Update Effective April 1, 2022, for Commercial Members |
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