Review claim editing enhancements  |  view in Web Browser


Blue Review

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

March 2022


Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

COVID-19 News and Updates
COVID-19 Vaccine Administration Codes M0220 and M0221 Benefits for Medicaid
COVID-19 Effective Jan. 21, 2022: Veklury (Remdesivir) is a Texas Medicaid Benefit
Low Pre-Adolescent Vaccine Rates: Best Practices for Promoting Vaccines for STAR Kids
Reporting Quality of Care Concerns
New Episodes of Medicaid Simplified: A Podcast for Texas Medicaid Providers
BCBSTX Electronic Visit Verification Provider Training
Medicaid and CHIP Requirements for Current Telehealth and Telemedicine
Interim Guidance for Synchronous Audiovisual Physical, Occupational, Speech Therapy Services
Free eLearning: Maternal Health Training for Providers maternal-health-training-providersAdobe Acrobat Icon


COVID-19 Provider Preparedness Updates

Check for continuing updates to our COVID-19 PreparednessCOVID-19 Provider Information for ERS Participants and COVID-19-related news on our News and Updates page.

It’s Here! New Look for the BCBSTX Provider Website

Our provider website has a new streamlined design and should enhance your online experience of easily finding the information you need. Information is still in the sections you’re used to seeing, such as:

Network Participation
Claims and Eligibility
Education and Reference
Clinical Resources
Standards and Requirements

All Providers Will Now Display in Provider Finder®

In October, we told you about the Consolidated Appropriations Act of 2021 and its requirements for provider directory information. One requirement is that all of our contracted providers must be listed in our Provider Finder, including those who chose not to be displayed in the past. Learn what this means for you and how to verify or update your information.

Read More

New Laboratory Management Program & Related Clinical Payment and Coding Policies to Begin on May 1, 2022

Effective May 1, we will implement a new program regarding claims for certain outpatient laboratory services. The program will: 

Ensure our members have access to the right care at the right time and in the right setting
Better prepare you to submit claims that support and reflect high quality, affordable care delivery to our members

The implementation of this program includes the posting of new Clinical Payment and Coding Policies. Review key points to help you prepare.

Read More


Technical and Professional Components

Modifier 26 denotes professional services for lab and radiological services. Modifier TC denotes a technical component for lab and radiological services. These modifiers should only be used in conjunction with the appropriate lab and radiological procedures. Note: When a health care provider performs both the technical and professional services for a lab or radiological procedure, he/she must submit the total service, not each individual service.

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:

Evaluation and Management (E/M) Coding – Professional Provider ServicesAdobe Acrobat Icon – Effective 05/01/2022
Laboratory Benefit Management Program (effective 05/01/2022) – Refer to the link for all Clinical Payment and Coding Policies related to this lab program


Reminder: Claim Editing Enhancements Coming April 1


Supporting Healthy Hearts

As you know, heart disease and stroke are among the leading causes of death in the U.S. As such, we encourage you to talk with our members about reducing and managing their heart-related risks. We’ve created resources that may help your discussions, including information on high blood pressure and cholesterol.

Read More

Imaging Studies for Low Back Pain

Evidence shows that unnecessary or routine imaging for low back pain is not associated with improved outcomes. Avoiding imaging for patients when there is no indication of an underlying condition can prevent unnecessary harm and unintended consequences to patients and can reduce health care costs.

Read More


Differential Diagnoses of Depression

On March 7 and 9, we held a one-hour webinar, Differential Diagnoses of Depression: Assessment and Treatment, a high-level overview of depression and differential diagnoses, as well as assessment and treatment. This introductory training focused on addressing depression in the primary care setting with treatment options across various care settings. Register or sign in to watch a recording of this webinar and earn one CME/CEU.

Read More


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.


Closing Gaps in Care for Group Medicare Advantage Members

In an effort to close gaps in care for Blue Cross Group Medicare Advantage (PPO)SM (Group MA PPO) members, you may receive records requests from BCBSTX or our vendor, Change Healthcare. We may request medical records for:

Risk adjustment gaps related to claims submitted to BCBSTX
Healthcare Effectiveness Data and Information Set (HEDIS®) measures
Centers for Medicare & Medicaid Services (CMS) Star Ratings
Read More

New Medicare Advantage Flex (PPO) Plan

The new Blue Cross Medicare Advantage Flex (PPO)SM Plan allows BCBSTX members to visit any provider in the U.S. who accepts Medicare. Read through questions and answers about the plan and how it may affect your payments.

Read MoreAdobe Acrobat Icon


Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2022 – Part 1

Review important benefit reminders, drug list changes, drug list updates and Utilization Management Program changes.

Read MoreAdobe Acrobat Icon


Update to Prior Authorization Codes for Commercial Members

We are updating our prior authorization lists for some commercial members. The updates reflect new, replaced or removed codes.

Read More

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.

Verify and Update Your Information

Verify your directory information every 90 days. Use the Provider Data Management feature on Availity® or our Demographic Change Form. You can also use this form to submit email addresses for you and your staff to receive the Blue Review each month.

Adobe Acrobat Icon File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at Leaving Site Icon.

Leaving Site Icon You are leaving this website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

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

1001 E. Lookout Drive, Richardson, TX 75082

© Copyright 2022 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe