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A newsletter for physician, professional, facility, ancillary and Medicaid providers |
April 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.
BEHAVIORAL HEALTH
2021 Behavioral Health Quality Improvement Program Evaluation Executive Summary
Review an analysis and evaluation of the effectiveness and key accomplishments of our Behavioral Health Quality Improvement program.
Read More
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Supporting Mental Health
More than half of Americans will be diagnosed with a mental illness or disorder at some point in their lives, according to the Centers for Disease Control and Prevention. We encourage you to talk with our members about their mental health and recommend treatment when needed. We provide a depression screening tool to help with this conversation.
| Read More |
Free Behavioral Health Webinars and Continuing Education Credit
Join us for free one-hour webinars in April (Diabetes and Behavioral Health) and May (Substance Abuse: Coordinating Care and Improving Follow‑Up). Each webinar provides one continuing medical education credit or continuing education unit. Registration is required.
| Read More |
CLAIMS & ELIGIBILITY
Change Coming to FEP Out-of-State Claims Processing
Currently, some out‑of‑area FEP® claims that are mistakenly submitted to a member’s Home Plan are manually forwarded to the appropriate local Plan where services were rendered. Effective June 15, we will no longer forward misdirected claims to the Host Plan for processing. Instead, we’ll deny these claims and instruct providers to resubmit them to the appropriate local Plan where the service was rendered.
| Read More |
ClaimsXtenTM Quarterly Update Effective June 13, 2022
We will implement our second quarter code updates for the ClaimsXten auditing tool on or after June 13. Code updates may include additions, deletions and revisions to:
| • | Current Procedural Terminology (CPT®) codes |
| • | Healthcare Common Procedure Coding System (HCPCS) codes |
| Read More |
Retinal Eye Exams and CPT II Coding
Many primary care providers (PCP) refer diabetic patients to eye care specialists for annual eye examinations. As such, we’re encouraging eye care specialists to share results routinely and promptly with PCPs. There is a specific Current Procedural Terminology CPT II code that indicates the documented communication of the eye exam findings to the PCP managing the diabetes care.
| Read More |
Hospitals and Routine Services and Supplies
Routine services and supplies are generally already included by a provider in charges related to other procedures or services. As such, these items are considered non-billable for separate reimbursement. The following guidelines may assist hospital personnel in identifying items, supplies and services that are not separately billable (this is not an all‑inclusive list):
| • | Any supplies, items and services that are necessary or otherwise integral to the provision of a specific service and/or the delivery of services in a specific location are considered routine services and not separately billable in the inpatient and outpatient environments. |
| • | All items and supplies that may be purchased over the counter are not separately billable. |
| • | All reusable items, supplies and equipment that are provided to all patients: |
| ◦ | During an inpatient or outpatient admission are not separately billable |
| ◦ | Admitted to a given treatment area or units are not separately billable |
| ◦ | Receiving the same service are not separately billable |
CLINICAL RESOURCES
Medical Necessity Review of Observation Services
As a reminder, it is our policy to provide coverage for observation services when it is determined to be medically necessary based on the medical criteria and guidelines outlined in the MCG Care Guidelines 
. Claims for observation services are subject to post‑service review, and we may request medical records for the determination of medical necessity.
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:
| • | CPCP013 Increased Procedural Services (Modifier 22) — Effective 3/7/2022 |
| • | CPCP030 Point‑of‑Care Ultrasound Examination Policy — Effective 3/7/2022 |
| • | CPCP031 Trauma Activation — Effective 3/7/2022 |
| • | TXCPCP03 Surgical and Non‑Surgical Services — Effective 3/10/2022 |
| • | CPCP014 Global Surgical Services — Professional Providers — Effective 6/13/2022 |
HEALTH & WELLNESS
To support quality care, we provide information to providers and members to encourage discussions on health topics. Watch for more on health care quality in our website’s News and Updates section and on our Wellness Can’t Wait web page.
Closing Gaps in Colon Care
Screening is the most effective way to reduce the risk of colorectal cancer, according to the Centers for Disease Control and Prevention (CDC). The CDC and the U.S. Preventive Services Task Force recommend that everyone ages 45 to 75 get a screening. We encourage you to discuss screening and colon health with our members. We’ve created resources that may help.
| Read More |
MEDICARE ADVANTAGE PLANS
Update to Prior Authorization Codes for Medicare Members Effective April 1
We are changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association. A summary of changes is included.
| Read More |
NETWORK PARTICIPATION
Verify and Update Your Information Online via Availity® Provider Data Management
The Availity Provider Data Management Tool offers providers a quick and easy way to update, validate and attest to the accuracy of their information on file with us. This multi-payer tool in Availity Essentials also allows you to make updates once and have that information sent to all participating payers.
| Read More |
PHARMACY
Pharmacy Benefits
As a reminder, certain drugs have quantity limits and/or may require prior authorization before we approve any benefits for the drug. Prior approval and quantity limits are in place to ensure we are following current medically appropriate drug guidelines.
| Read More |
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Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, |
1001 E. Lookout Drive, Richardson, TX 75082
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