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Blue Review

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

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®) MeasuresAdobe Acrobat Icon
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.

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Provider Self Service Tools via Availity® Essentials

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

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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.

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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.

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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 Oct. 1, 2022
CPCP010 Anesthesia InformationAdobe Acrobat Icon – effective Dec. 22, 2022
CPCP009 Co-Surgeon/Team Surgeon ModifiersAdobe Acrobat Icon – effective Feb. 1, 2023
CPCP018 Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS CodesAdobe Acrobat Icon – effective Feb. 1, 2023
CPCP008 Psychological and Neuropsychological TestingAdobe Acrobat Icon – 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.

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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.

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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 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.



MyBlue HealthSMNetwork Expansion
UT CARETM Medicare PPOAdobe Acrobat Icon


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.

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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.

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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 HealthSelectSM participants.

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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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