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A newsletter for physician, professional, facility, ancillary and Medicaid providers |
March 2022
MEDICAID
Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers
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 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 |
| • | Pharmacy |
| • | 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 |
CLAIMS & ELIGIBILITY
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 Services – 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:
| • | Reminder: Claim Editing Enhancements Coming April 1 |
CLINICAL RESOURCES
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 |
EDUCATION & REFERENCE
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 |
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
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.
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Read More
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PHARMACY
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.
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Read More
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PRIOR AUTHORIZATION
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 |
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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
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