March 2021

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:

• COVID-19 News and Updates
• Available Resources to Provide Personal Protective Equipment for the Consumer Directed Services Option
• CAHPS^® Getting Care Quickly
• Indices Helps Compliance with THSteps^® and HEDIS^® Measures

COVID-19 Provider Preparedness Updates

As the COVID-19 crisis evolves, we’re continuing to make updates on our COVID-19 Preparedness and our COVID-19 Related News pages. Be sure to check these pages frequently for updates including COVID-19: Texas Provider FAQs and COVID-19: FAQs for Medicare Providers.

System Issue Sending Incorrect Provider Term Notice to Members

We are aware of a system error that’s causing members to receive letters stating their provider is no longer in network. Our technical team is implementing a system fix (targeted for second quarter 2021) to correct the issue.

Blue Essentials Access^SM and Blue Premier Access^SM Plans Reminder

BCBSTX providers who sign a Blue Essentials^SM or Blue Premier^SM agreement are also in-network for the Blue Essentials Access^SM or Blue Premier Access^SM plans. Review the components of these plans.

Wellness Can’t Wait

Prevention is still important during the COVID-19 pandemic. Download a toolkit that can help you encourage your patients to get caught up on their health – including vaccinations.

Register for Indices Training to Learn How it Can Help You Close Member Care Gaps

You can leverage Indices to access a range of insights about the BCBSTX members you are treating, including quality and risk metrics. Indices data is easy to navigate and can help:

• Improve quality of care by identifying gaps in care as reflected in claims and other regularly updated data. This may include wellness exams, screenings or other preventive care.
• Identify risks for chronic conditions and the severity of any conditions.

Use this flier to see our available trainings and sign up for a time that works for you.

Reminders:

• COVID-19 Vaccines and Coverage
• Telehealth 2021

2020 Behavioral Health Quality Improvement Program Evaluation Executive Summary

Review a 2020 analysis and evaluation of the overall effectiveness and key accomplishments of our Behavioral Health Quality Improvement Program.

Reminder:

• Tiered Payment Rate Modifiers for ABA Effective April 1, 2021

CPT^® Category II Codes Can Help Close Care Gaps

Using the proper Current Procedural Terminology (CPT) Category II codes when filing claims can help streamline your administrative processes and ensure gaps in care are closed.

Overpayment of Multiple Surgical Procedures

On June 1, 2021, we will begin additional reviews of claims after payment to make sure they adhere to our reimbursement policy for multiple surgical procedures.

Telehealth Claim ‘Place of Service’

Providers are responsible for accurately coding services performed on their claims. When submitting telehealth professional services using a HCFA 1500, the claims when billed with a telehealth procedure code or another CPT^® or HCPCS procedure code with telehealth modifiers (G0, GT, GQ, or 95), need to be billed with place of service (POS) 02. Starting May 1, 2021, if professional telehealth services are billed without POS 02, claims may be rejected and must be resubmitted with the correct POS. If you have any questions, please contact your Network Management Representative.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies 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 have been recently added or updated:

• Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)  – Effective 05/15/2021
• Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy  – Corrected effective date 04/05/2021

Medical Record Data Collection for Quality Reporting Begins Feb. 1

To meet HEDIS^® 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 to 5 business days.

Predetermination of Benefits List

A predetermination of benefits is a voluntary request for written verification of benefits before rendering services. We recommend submitting a predetermination of benefits request if the service may be considered experimental, investigational or unproven. We’ve developed a list of codes where predetermination may be available and is recommended.

Get the Conversation Started on Colorectal Cancer

Your discussion is the number one influence on your patients’ compliance with colorectal cancer. Talk to your patients about the importance of having a screening and the different screening options available.

Reminder:

• Contracting and Credentialing Mid-level Providers

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 — Part 1

Review drug list changes, updates and revisions that go into effect April 1.

Reminder:

• Update to Prior Authorization Codes for Commercial Members

Termination of Unused Provider Record ID

We may automatically cancel a Provider Record ID that does not have any claim dates of service within a 12-month period. Terminating a Provider Record ID will also result in termination of associated networks. Provider Record IDs are specific to billing/rendering NPIs and Tax Identification Numbers. If you have any questions, contact your Provider Network Representative.

Professional Provider Insurance Liability Limits

We require in-network office-based physicians and professional providers to maintain minimum amounts of insurance coverage for professional liability risk. Effective March 1, 2021, the new required minimum amounts for office based professional providers is $100,000 per occurrence and $300,000 aggregate. If you have any questions, contact your local Network Management Office.

bcbstx.com/provider

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