Removal of Services Requiring Inpatient and Outpatient Prior Authorization  |  view in Web Browser


Blue Review

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

October 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 Vaccine Administration Codes 0041A and 0042A Are Now Benefits for Medicaid and CHIP
COVID-19 Procedure Codes Added to Healthcare Common Procedure Coding Systems for Texas MedicaidAdobe Acrobat Icon
Update to Prior Authorization Codes for Medicaid Members, Effective Oct. 1, 2022
Antidepressant Medication Adherence
Kate Farms Voluntary Formula Recall Expanded
Case Management for Children and Pregnant Women Carve-In and Provider Professional Liability Insurance
Medicaid and CHIP Fee-for-Service for Telehealth and Telemedicine Updates Effective Sept. 1, 2022
Notice of Payment Change for Prescribed Extended Care Centers Service ProvidersAdobe Acrobat Icon
Influenza (FLU) Season 2022-2023



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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Earn Continuing Education Credit through Webinar on Suicide Prevention

Join us for a free, one-hour webinar, Suicide Prevention with the Military Community, on Thursday, Nov. 3, at 9 a.m. CT. Those who attend will earn one continuing medical education credit or continuing education unit. The webinar will address behavioral health conditions impacting veterans and strategies for intervention and treatment.

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New ‘Message This Payer’ Option via Availity® Essentials

Effective Oct. 3, a new digital Message This Payer option is available for you to resolve your claim inquiries online. You can use this electronic method to send us secure messages for claim management questions.

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Submitting Unlisted or Miscellaneous Codes: Billing Guidelines and Reminders

Avoid documentation requests from us by describing specific drugs, services, supplies or procedures when using an unlisted or miscellaneous code. 

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ClaimsXtenTM Quarterly Update Effective Dec. 5, 2022


Antidepressant Medical Management

It’s well documented that many patients who are prescribed antidepressants do not take their medication as recommended. Therefore, we’re providing a checklist and resources to help practitioners educate their patients on the importance of medication adherence.

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Addressing Disparities in Breast Cancer for Black Women

Although breast cancer is one of the most common cancers among women in the U.S., it disproportionately affects Black women. As such, we’re providing you tips and resources to help improve this disparity.

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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 09/01/2022
CPCP035 Unlisted/Not Otherwise Classified (NOC) Coding PolicyAdobe Acrobat Icon – Effective 09/20/2022
CPCP029 Medical Record DocumentationAdobe Acrobat Icon – Effective 12/26/2022

Utilization Management Decisions

We are dedicated to serving our customers through the provision of health care coverage and related benefit services. Utilization Management (UM) determinations are made by licensed clinical personnel based on the: 

benefits policy (coverage) of a member’s health plan,
evidence-based medical policies and medical necessity criteria, and the
medical necessity of care and service.

All UM decisions are based on appropriateness of care and service and existence of coverage. We prohibit decisions based on financial incentives, nor do we specifically reward practitioners or clinicians for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization. 

The criteria used for UM determinations are available upon request by calling the customer service or health advocate number on the back of the member’s ID card.


Educational Webinar Sessions

We’ve added additional trainings to our Educational Webinar Sessions webpage. Complimentary training opportunities include:

AIM ProviderPortalSM Training for Prior Authorizations
Authorizations & Referrals via Availity Essentials
Availity Essentials Orientation – Save Time and Go Online
Behavioral Health – Free CME/CEU Webinars
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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.

Health Equity and Social Determinants of Health: New Resources for Providers

To address gaps in health care, we’re offering a new Health Equity and Social Determinants of Health (SDoH) webpage that’s dedicated to improving access to care for all of our members. The webpage aims to define what SDoH is, how we’re addressing it and how you can help.

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Well onTarget® Resources Reminder for Your Patients

Well onTarget provides members a digital wellbeing experience through online health coaching and a fitness program. It also empowers them to reach their wellness goals and encourages them to share their Healthcare Provider Reports with you to help close gaps in their care.

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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 will be able to check their status online via Availity.

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Prior Authorization Changes for Inpatient Services Effective Oct. 1, 2022

We’re removing the prior authorization requirement for some inpatient services for Fully Insured plans (TDI on ID card) and certain Commercial groups. As such, beginning Oct. 1, the following inpatient services will no longer require prior authorization:

Elective Acute (Medical, Hospice, Maternity, Surgical, Transplant)
Elective Post-Acute (LTAC, Rehab, SNF)
All Behavioral Health Elective Inpatient (Rehab and Residential Treatment Center)
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Removal of Outpatient Services Requiring Prior Authorization Effective Sept. 18, 2022

Effective Sept. 18, we are removing the prior authorization requirement for some outpatient services for Fully Insured plans (TDI on ID card) and certain Administrative Services Only (ASO) groups, including:

Durable Medical Equipment (DME)
Physical Therapy, Occupational Therapy and Speech Therapy (PT/OT/ST) – Except Coordinated Home Care (home health) services continue to require PA.
Chiropractic Services
Dental/Accident Injury
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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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