Updated Prior Authorization Codes for Medicare Advantage | view in Web Browser
A newsletter for physician, professional, facility, ancillary and Medicaid providers |
November 2022
MEDICAID
Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers
NOTICES & ANNOUNCEMENTS
MyBlue HealthSM Network Expansion
Effective Jan. 1, we will expand the MyBlue Health network to Cameron and Hidalgo (the Valley service area), Collin, Denton, Tarrant (Dallas service area) and El Paso counties.
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UT CARETM Medicare PPO
As a reminder, on Jan. 1, 2023, approximately 30,000 retirees from the University of Texas System (UTS) will become members of UT CARE Medicare PPO (UT CARE). UT CARE is our open access Medicare Advantage PPO plan for UTS retirees.
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BEHAVIORAL HEALTH
Diabetes and Depression
Because there are numerous considerations for people living with diabetes – such as medication management, managing multiple comorbidities and monitoring their blood glucose – diabetics are at risk of developing psychological conditions. Help empower your patients to manage their care.
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Provider Depression Disorder Prescribing
Proper treatment of depression has been proven to effectively reduce symptoms, and decrease relapses, emergency department visits and hospitalization rates. Screening should utilize evidence-based tools to ensure accurate diagnosis, efficient treatment and appropriate follow-up. Leveraging telemedicine for mental health may allow an otherwise reluctant member to receive desperately needed care, reduce health disparities and resolve treatment gaps.
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CLINICAL RESOURCES
Kidney Health Evaluation for Patients with Diabetes
We’re providing tips to consider when evaluating the kidney health of patients with diabetes.
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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 policy was added or updated:
| • | CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Update – Effective 1/1/2023 |
EDUCATION & REFERENCE
Continuity of Care is Driven by Prompt Communication Upon Hospital Discharge
We’re providing important information to help you when discharging Federal Employee Program® (FEP®) members after inpatient hospital stays.
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Keeping an Eye on Improved Provider Collaboration
Communication between providers is key to positive outcomes for patients. Since many PCPs refer their patients with diabetes to eye care specialists for exams, it’s important that the specialists routinely and promptly share results with the referring PCPs.
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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.
Diabetes Screening for People Using Antipsychotic Medications
According to the NCQA, people with serious mental illness who use antipsychotic medications are at increased risk of diabetes. As such, we’re providing tips to help close gaps in care for this population.
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Importance of Early and Timely Intervention for Pre- and Post-Partum Care to Help Improve Health Outcomes
Review information about the importance of communication between health care professionals and their patients during a patient’s pre-pregnancy, pregnancy and postpartum journey.
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MEDICARE ADVANTAGE PLANS
Chiropractor Medicare Physician Fee Schedule Increase for Medicare Advantage PPOSM
Effective Jan. 1, 2023, we will implement an increase in the maximum allowable fee schedule for some procedure codes.
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Update Prior Authorization Codes for Medicare Advantage Effective Jan. 1, 2023
We are changing prior authorization requirements for Medicare Advantage members to reflect new, replaced or removed codes, including:
| • | Addition of sleep drug codes to be reviewed by eviCore® |
| • | Addition of a radiation oncology code to be reviewed by eviCore |
| • | Addition of specialty drug codes to be reviewed by eviCore |
| • | Addition of prior authorization codes to be reviewed by BCBSTX |
| • | Removal of prior authorization codes previously reviewed by BCBSTX |
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PHARMACY
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2022 – Part 2
Review important pharmacy benefit reminders, drug list updates and Utilization Management program changes.
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PRIOR AUTHORIZATION
Prior Authorization Exemption Status via Availity® Essentials
As a reminder, due to our implementation of Texas House Bill 3459 for Prior Authorization (PA) Exemption(s), providers who have met the criteria to be reviewed for PA exemption(s) for particular services are able to check their status online via Availity as of Oct. 1, 2022.
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