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Blue Review

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

February 2022


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:

COVID-19 News and Updates
Alert: Reminder to Encourage Medicaid Members to Renew CoverageAdobe Acrobat Icon
Claim Editing Enhancements Coming Feb. 23
BCBSTX Medicaid Supplemental Data Sets
Common Errors in Texas Health Steps® (THSteps) Preventative Exams
COVID-19: THSteps Remote Delivery of Medical CheckupsAdobe Acrobat Icon
Applied Behavioral Analysis for Children with Autism Spectrum Disorder
Availity® Provider Learning OpportunitiesAdobe Acrobat Icon
Alert: Effective 2/1/2022 Applied Behavior Analysis ServicesAdobe Acrobat Icon


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.

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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.

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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.

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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 ReadmissionsAdobe Acrobat Icon – Effective 1/1/2022
CPCP006 Preventive ServicesAdobe Acrobat Icon – Effective 1/1/2022
CPCP016 Chiropractic Care ServicesAdobe Acrobat Icon – Effective 1/14/2022
CPCP002 Inpatient/Outpatient Unbundling - FacilityAdobe Acrobat Icon – Effective 1/14/2022
CPCP004 Neonatal Intensive Care Unit (NICU) Level of Care Authorization and ReimbursementAdobe Acrobat Icon Effective 1/14/2022
CPCP017 Wasted/Discarded Drugs and BiologicalsAdobe Acrobat Icon – Effective 1/14/2022
CPCP018 Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT, HCPCS and/or NDC CodesAdobe Acrobat Icon – Effective 3/22/2022
CPCP022 Pneumatic Compression Devices – Outpatient UseAdobe Acrobat Icon – Effective 04/12/2022
CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)Adobe Acrobat Icon – Effective 04/15/2022


Claim Editing Enhancements Are Coming April 1


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.

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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.



Blue Cross Medicare AdvantageSM Prior Authorization Code Update Effective April 1, 2022


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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Prior Authorization Code Update Effective April 1, 2022, for Commercial Members

Regulatory & Requirements

This section includes additional items related to regulatory requirements and operational processes to assist provider offices with servicing our members. Access this month’s articlesAdobe Acrobat Icon.

We are required to provide certain notices in all published correspondence with health care providers. For the latest updates, visit the News and Updates section on the BCBSTX provider website.

Printable PDF

View a printable PDF 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.


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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

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