December 2022

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

•	Indices Helps Compliance with Texas Health Steps and Healthcare Effectiveness Data and Information Set (HEDIS®) Measures
•	BCBSTX HEDIS MY2022
•	How Providers Can Improve Patient Satisfaction Scores
•	Update to Prior Authorization Codes for Medicaid Members, Effective Jan. 1
•	STAR Kids Long-Term Services and Support Billing Update
•	No Copayments for CHIP COVID-19 Services and Provider Attestation Forms
•	Reminder: Change to Signature Requirements for Home Health Services
•	Reminder: BCBSTX Appointment Accessibility Standards

Reduction of Prior Authorization Requirements for Certain Applied Behavioral Analysis (ABA) Codes for Commercial Members

Based on a prior authorization exemption or claims history, prior authorization requests for some ABA Assessment CPT^® codes may not be needed.

Provider Self Service Tools via Availity^® Essentials

Review the benefits of using Availity Essentials for self-service pre-service and post-service resources.

Confirm Medical Record Receipt Status Online for Prior Authorization Requests

Through Availity Essentials, you can now use the Medical Record Status Viewer to confirm receipt of medical records submitted by fax or mail for prior authorization requests and claims.

Statin Therapy for Patients with Cardiovascular Disease and Diabetes

To monitor and improve our members’ care, we track the quality measures of statin therapy related to cardiovascular disease and diabetes. You can help ensure quality care by following recommended guidelines from the National Committee for Quality Assurance.

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 Oct. 1, 2022
•	CPCP010 Anesthesia Information – effective Dec. 22, 2022
•	CPCP009 Co-Surgeon/Team Surgeon Modifiers – effective Feb. 1, 2023
•	CPCP018 Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS Codes – effective Feb. 1, 2023
•	CPCP008 Psychological and Neuropsychological Testing – effective Feb. 8, 2023

The Magellan Connection: Partnering and Collaborating with PCPs for Better Patient Outcomes

Magellan Healthcare^® is contracted to perform behavioral health managed care functions for BCBSTX HMO members and participants. Providers can work with their patients’ care managers to help determine the most appropriate resources for patient needs and preferences.

Magellan’s Webinar Series:  Improve Patient Outcomes with Quality Measures

Care coordination is an integral component of the relationship between behavioral health providers and primary care providers. It is especially important for members with chronic conditions who are receiving care from various settings. Magellan has a series of webinars to assist PCPs with recommendations and guidance on crucial HEDIS measures.

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 Delivering Quality Care web page.

Help Close Gaps in Care for Group Medicare Advantage Members

If we need medical records for Blue Cross Group Medicare Advantage (PPO)^SM members, you will receive requests only from Blue Cross and Blue Shield of Texas or our vendor, Change Healthcare. This is part of the Blue Cross and Blue Shield National Coordination of Care program so that providers won’t receive requests from multiple BCBS plans or their vendors. Please respond quickly to our requests, including requests related to risk adjustment gaps and Healthcare Effectiveness Data and Information Set (HEDIS) measures.

Reminders:

•	MyBlue HealthSMNetwork Expansion
•	UT CARETM Medicare PPO

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2023 – Part 1

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

Update to Prior Authorization Code Changes for Commercial Members, Effective Jan. 1

We will be updating our lists of Current Procedural Terminology codes requiring prior authorization to reflect new, replaced or removed codes for commercial members.

Prior Authorization Update Notice for HealthSelect of Texas^® Network Providers Effective Jan. 1

Effective Jan. 1, certain procedure codes will be updated to require prior authorization for HealthSelect of Texas and Consumer Directed HealthSelect^SM participants.

bcbstx.com/provider

File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe^® Reader^® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at https://www.adobe.com .

You are leaving this website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non‑Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

1001 E. Lookout Drive, Richardson, TX 75082

© Copyright 2022 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe