November 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
•	Provider Notification of Member Mammogram Screening in Austin, TX
•	BCBSTX Changes Customer Service Hotline Hours
•	New Process for Private Duty Nurses Denials for Texas Medicaid
•	Changes to Outpatient Ratio of Cost to Charges for Rural Hospitals Went into Effect Sept.1
•	Free eLearning: Maternal Health Training for Providers
•	Delivering Quality Care – Managing Diabetes
•	Remind Patients to Get Influenza Vaccination
•	Provider Talking Points for High Priority Measure

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.

Update to Prior Authorization Codes for Commercial Members

Soon we’ll update our lists of Current Procedural Terminology (CPT^®) codes that require prior authorization to reflect new, replaced or removed codes.

Consolidated Appropriations Act & Transparency in Coverage Final Rule

The Consolidated Appropriations Act of 2021 and the Transparency in Coverage Final Rule will impact most of our members starting Jan. 1, 2022. As providers caring for them, you will be impacted as well.

Depression Disorder Prescribing

After a positive depression screening, providers should advise their patients on screening results, provide an individualized, evidence-based treatment plan, and a referral to behavioral health, when needed.

Claim Editing Enhancements Coming Jan. 10, 2022

Effective Jan. 10, 2022, we’ll enhance our claims editing and review process with Cotiviti, Inc. to ensure accurate coding of services and that services within the global surgical period are properly reimbursed.

Introducing Electronic Clinical Claim Appeal Requests via Availity^®

This month we’ll launch a new and convenient electronic capability to submit appeal requests for specific clinical claim denials through the Availity Provider Portal (for commercial members). Review steps to submit appeal requests for clinical claim denials online.

Streamlining Coordination of Benefits for Members with Secondary Coverage

We’ve been working with the Council for Affordable Quality Healthcare (CAQH) to identify commercial members with more than one health insurance policy. Historically, coordinating payments for members with multiple policies has been a lengthy, manual process. By collaborating with CAQH, we’re working to reduce administrative burdens and timelines required to coordinate these claims, resulting in faster and more accurate claims payments to you.

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 have been recently added or updated:

•	CPCP006 Preventive Services Policy – 10/01/2021
•	CPCP029 Medical Record Documentation Guideline  – Effective 12/01/2021
•	CPCP010 Anesthesia Clinical Payment and Coding Policy  – Effective 12/29/2021
•	CPCP035 Unlisted/Not Otherwise Classified (NOC) Coding Policy  – Effective 01/08/2022

2022 Telemedicine and Telehealth Services

In support of our members and employer groups, in 2022, we will continue covering expanded telemedicine and telehealth services. We are still evaluating our members’ needs and may add services to our coverage. We’ll provide a final code list in the coming months.

Avoiding Antibiotics for Acute Bronchitis

As you know, antibiotics only treat certain bacterial infections and don’t work against viruses, which are often the cause of acute bronchitis, colds and flu. Review tips to consider from the CDC about alternatives to antibiotics for acute bronchitis and other conditions.

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.

Catch Up on Vaccines for All Ages

The COVID-19 pandemic has significantly disrupted routine immunizations for children, adolescents and adults, according to the U.S. Department of Health and Human Services. Review our preventive care guidelines and how to close this gap in care.

Reminder:

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021 – Part 2

This article is a continuation of the previously published Quarterly Pharmacy Changes Part 1 article. While that Part 1 article included the drug list revisions/exclusions, dispensing limits, utilization management changes and general information on pharmacy benefit program updates, this Part 2 version contains the more recent coverage additions, utilization management updates and any other updates to the pharmacy program.

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an Independent Licensee of the Blue Cross and Blue Shield Association

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