February 2020

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:

• HEDIS^® 2020
• Texas Health Steps for Preventing Oral Health Diseases in Children

New Prior Authorization & Referral Submission Tool via Availity^® and Provider Portal

What’s changing: Soon you can begin using Authorizations & Referrals, our new online prior authorizations tool, which is easy to use with only five steps.

Reminder: Fee Schedule Update March 1, 2020

Coming soon: Effective March 1, BCBSTX is changing the maximum allowable fee schedule for the following networks:

• Blue Choice PPO^SM
• Blue Essentials^SM (including HealthSelect^SM of Texas Network)
• Blue Premier^SM
• Blue Advantage HMO^SM
• MyBlue Health^SM
• PAR Plan

Updates to Behavioral Health Clinical Practice Guidelines

With members in mind: The Behavioral Health Guidelines have been updated to include links to information about various Care Management programs. These programs aim to improve health outcomes for members and reduce medical care claims.

Reminders:

• Magellan^® Connection 2019: Partnering with PCPs to Manage Behavioral Health Care Needs
• Magellan’s New Webinar Series: HEDIS Measures and a Focus on Coordination of Care
• Behavioral Health Measures from HEDIS

Two New ClaimsXten^TM Rules to be Implemented in 2020

Making improvements. ClaimsXten software will be updated to better align coding with the reimbursement of claims. On April 20, the following two rules will be updated:

1. Bilateral Services for Professional Claims
2. Modifier to Procedure Validation Filter – Non-payment Modifiers

Reminder: Medicare Beneficiary Identifier Must be Submitted on Claims

Date check. This is a reminder that Dec. 31, 2019, was the last date that claims could be submitted using the old Health Insurance Claim Numbers. Effective Jan. 1, 2020, regardless of the date of service, all claims must be submitted using the new Medicare Beneficiary Identifier number.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding policies published on our website describe payment rules and methodologies for CPT^®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is offered as 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 policy was recently added:

• Preventive Services – effective Jan. 1, 2020

Reminders:

• New Blue Cross Medicare Group Plan Names and ID Cards
• Medicare Outpatient Observation Notice Required – Annual Reminder
• Pharmacist Healthcare Services
• Medicare Providers May Not Bill Participants in the Qualified Medicare Beneficiary Program
• National Coordination of Care^SM Program for Group Medicare Advantage PPO Members
• Reminder of Change to the Pre-service Appeals Process for Your Blue Cross Medicare Advantage^SM Patients
• Medicare Advantage: Interpreting the ‘PLB’ Segment on the 835 ERA
• Medicare Advantage: Additional Payment for Medication Reconciliation Post Discharge
• 2020 Holiday Schedule Reminders (for 835 and 837 Transactions)
• Change to Online Enrollment Process for 835 EFT & ERA through Availity
• Availity Remittance Viewer Upgrade

Coordinating Care Between Behavioral Health and Medical Providers

Sharing information = improved health outcomes. A Coordination of Care form is now available for behavioral health and medical care providers to request patient information from each other. To improve patient outcomes, consulting and referring providers should share information with each other such as diagnoses, medications, treatment plans and recommendations.

Annual Medical Record Data Collection for Quality Reporting Begins Feb. 1, 2020

Things to know: Texas state law requires HMOs in Texas to report HEDIS data to the Department of State Health Services on an annual basis. Therefore, a representative from CIOX – our contracted vendor – or BCBSTX staff may be contacting your office/facility between February and May to request information to meet the requirements.

Reminder:

• Reminder Medicare Advantage Program 30-Day Readmission Facility

HMO Plans – PCP Selection and Referral Requirements 2020

The rundown: There are various HMO plans and those plans have different requirements for referrals and services, and the addition of information on MyBlue Health. Make sure you’re in-the-know by reviewing the criteria.

Prior Authorization Changes for Certain BCBSIL Members in Texas

New prior authorization requirements for some Blue Cross and Blue Shield of Illinois (BCBSIL) members in Texas go into effect March 1. Know which three-character prefixes on ID cards are impacted and which services require prior authorization.

Reminders:

• New Prior Authorization Requirements for Blue Cross Medicare Advantage Beginning Jan. 1, 2020
• 2020 New Prior Authorization Requirements and Introduction of MyBlue Health

Reminders:

• Pharmacy Program Updates: Quarterly Pharmacy Changes – Part 1
• Pharmacy Program Updates: Quarterly Pharmacy Changes – Part 2

Reminders:

• Reminder: Out-of-Network Medicare Providers Can Treat Group Medicare Advantage Open Access (PPO) Members
• Physician Efficiency, Appropriateness and Quality (PEAQ) Program Measuring and Maximization
• 2020 Blue Cross Medicare Advantage Expansion Service Areas

Attend Free Provider Training Webinars

Whether new to these resources or if you need a refresher, there are many webinars available at no charge to learn about Availity – including Availity Authorizations – eviCore and the remittance viewer.

bcbstx.com/provider

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