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 Services
•	The Most Common Causes for Maternal/Fetal Morbidity
•	Perinatal Social Determinants of Health
•	Texas Medicaid Claims Editing Enhancements Effective Oct. 25, 2022
•	Alert: Updates to STAR Kids Long-Term Services and Supports Billing Matrix for Dec. 1, 2022

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.

Physician Efficiency, Appropriateness & Quality (PEAQ^SM) 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.

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.

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 Policy — Effective 07/01/2022
•	CPCP015 Multiple Surgical Procedures - Professional Provider Services — 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.

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 Advantage^SM 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.

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.

New BCBSTX MyBlue Health^SM 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.

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.

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 HealthSelect^SM) participants enrolled in the in-area and out-of-state plans. HealthSelect Secondary participants are not included.

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 ProviderPortal^SM and the Medical Oncology program.

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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