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Blue Review

A newsletter for physician, professional, facility, ancillary and Medicaid providers

August 2022


Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

COVID-19 News and Updates
COVID-19 Moderna Vaccine Administration Codes 0011A, 0012A, and 0013A for Ages 12 and Older
Reminder: Federal Entitlement to Medicaid and Early Childhood Intervention ServicesAdobe Acrobat Icon
The Most Common Causes for Maternal/Fetal Morbidity
Perinatal Social Determinants of Health
Texas Medicaid Claims Editing Enhancements Effective Oct. 25, 2022Adobe Acrobat Icon
Alert: Updates to STAR Kids Long-Term Services and Supports Billing Matrix for Dec. 1, 2022Adobe Acrobat Icon


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.

Annual Notice of Provider and Member Rights and Responsibilities

As a participating provider in our networks, you have certain rights and responsibilities that may affect your practice. Your patients also have rights and responsibilities.

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Physician Efficiency, Appropriateness & Quality (PEAQSM) Reports and Training Coming Soon

In August, PEAQ Provider Performance Insights (PPI) reports will be available to qualifying physicians. The PEAQ program evaluates physicians’ performance in a transparent and multidimensional way. Please review informational materials to understand PPIs and attend training sessions to get acquainted with PEAQ.

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New Online Option to Confirm Medical Record Receipt Status

There’s a new application in our BCBSTX-branded Payer Spaces section on Availity® Essentials that you can use to check whether we’ve received submitted medical records for claims processing.

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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 were added or updated:

CPCP006 Preventive Services PolicyAdobe Acrobat Icon — Effective 07/01/2022 
CPCP015 Multiple Surgical Procedures - Professional Provider ServicesAdobe Acrobat Icon — Effective 07/01/2022 


Language Line Supports Cultural Competence

Our Language Line provides translation services for hundreds of languages to providers and members free of charge. Learn how it works and get reminders about the importance of cultural competence.

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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.


Reviewing Inpatient DRG Claims for BlueCard® Medicare Advantage Members

The Blue Cross and Blue Shield Association requires us to review select inpatient, diagnosis-related group claims for any out-of-area Blue Cross Medicare AdvantageSM members. Beginning Oct. 15, we will work with our vendor, CERiS, to complete these reviews, which will check for compliance with ICD-10 procedure coding system guidelines.

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Update to Prior Authorization Codes for Medicare Advantage Members, Effective Oct. 1, 2022

In October, we’ll change our prior authorization requirements for Medicare Advantage members to reflect new, replaced or removed codes due to updates from our Utilization Management department or the American Medical Association.

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New BCBSTX MyBlue HealthSM Counties Expansion in 2023

Effective Jan. 1, 2023, we’ll expand our MyBlue Health network to the counties listed below. As a reminder, MyBlue Health members access care through providers contracted in the MyBlue Health network.

Cameron and Hidalgo – The Valley
Collin, Denton and Tarrant – Dallas Service Area
El Paso
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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2022 – Part 2

Review important pharmacy benefit reminders, drug list updates and Utilization Management program changes.

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Medical Oncology Prior Authorizations Transition to AIM Specialty Health® for ERS

Starting Sept. 1, AIM Specialty Health (AIM) will begin managing prior authorization requests for the Specialty Drug Medical Oncology Care category for HealthSelect of Texas® (including Consumer Directed HealthSelectSM) participants enrolled in the in-area and out-of-state plans. HealthSelect Secondary participants are not included.

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Training for Pharmacy Medical Oncology Through AIM

As indicated above, AIM will be managing requests for HealthSelect of Texas. It’s important to attend an online training session for more in-depth information on key dates including a preview of the AIM ProviderPortalSM and the Medical Oncology program.

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Update to Prior Authorization Codes for Commercial Members, Effective Oct. 1, 2022

In October, we’ll update our lists of Current Procedural Terminology® codes that require prior authorization (for some commercial members), to reflect new, replaced or removed codes due to updates from our Utilization Management department or the American Medical Association.

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Regulatory & Requirements

This section includes additional items related to regulatory requirements and operational processes to assist provider offices with servicing our members. Access this month’s articlesAdobe Acrobat Icon.

We are required to provide certain notices in all published correspondence with health care providers. For the latest updates, visit the News and Updates section on the BCBSTX provider website.

Printable PDF

View a printable PDF Adobe Acrobat Icon of the non‑Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

Verify and Update Your Information

Verify your directory information every 90 days. Use the Provider Data Management feature on Availity® or our Demographic Change Form. You can also use this form to submit email addresses for you and your staff to receive the Blue Review each month.

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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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