Removal of Services Requiring Prior Authorization  |  view in Web Browser


Blue Review

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

September 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 0081A, 0082A, 0083A, 0111A, 0112A, 0113A, Are Now Benefits for Medicaid and CHIP
COVID-19 Vaccine Administration Codes 0091A, 0092A, 0093A, Are Now Benefits for Medicaid and CHIP
Provider Enrollment and Management Systems
Alert: Case Management for Children and Pregnant Women Effective 09/01/2022Adobe Acrobat Icon
Code T1015 Modifiers for Texas Medicaid Indian Health Care Providers
Primary Care Physician Signatures Requirements for Private Duty Nurse
Quality Management Member Outreach for Closing Care Gaps
Addressing Disparities in STAR Kids Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Approved Provider Types for Teleservices
Texas Medicaid Claims Editing Enhancements Effective Nov. 25, 2022Adobe Acrobat Icon


Videos to Share on Behavioral Health Care

With behavioral needs on the rise, we’re providing related videos you can show patients in your waiting rooms. You can also share links to the videos in your patient portals and discharge paperwork. Spanish captions are available.

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Reimbursement Increase

Effective Aug. 1, we increased the maximum allowable standard fee schedule reimbursement for some specialties.

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Reminders When Using the Claims Inquiry Resolution Tool

Learn how to be more efficient and save time with the Claim Inquiry Resolution Tool when submitting claim reconsideration requests for certain finalized claims.

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ClaimsXtenTM Quarterly Update Effective Dec. 5, 2022

We’ll implement our Q4 code updates for the ClaimsXten auditing tool on or after Dec. 5. Updates may include additions, deletions or revisions to:

Current Procedural Terminology (CPT®) codes
Healthcare Common Procedure Coding System (HCPCS) codes
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Are You Using These Shared Decision-Making Aids?

When doctors and their patients collaborate on treatment plans, it can lead to improved patient experiences, better outcomes and quality of life. As such, we’re providing evidence-based resources about treatment options, lifestyle changes and outcomes to help you with patient conversations.

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Avoiding Antibiotics for Acute Bronchitis and Other Viruses

With the start of flu and cold season, patients may request antibiotics to treat their symptoms. But as you’re aware, antibiotics only treat certain bacterial infections. Therefore, we’re providing resources to help you educate your patients about appropriate antibiotic use.

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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.


Webinars on Cross-Cultural Care for Continuing Education Credit

If you’re wanting to expand your understanding of cross-cultural care, we’re offering six different webinars at no cost through Quality Interactions, a separate company that provides cultural awareness training to health care professionals.

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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.

Help Close Diabetes Disparity Gaps

According to the CDC, more than 37 million Americans of all ages have diabetes. An estimated 96 million Americans have prediabetes or are at high risk for type 2 diabetes. And data shows that diabetes disproportionately impacts certain populations. As such, we're providing tips on how you can help remove barriers to health equity and close gaps in care.

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Closing 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 (BCBSTX) or our vendor, Change Healthcare. This is part of the Blue Cross and Blue Shield (BCBS) National Coordination of Care program so that you 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.

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Reviewing Inpatient DRG Claims for BlueCard® Medicare Advantage Members
Update to Prior Authorization Codes for Medicare Advantage Members, Effective Oct. 1, 2022


Verify Your Directory Details Every 90 Days

As a reminder, the Consolidated Appropriations Act of 2021 requires that certain directory information be verified every 90 days. Review which information must be verified, how to verify it and how to update it.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2022 – Part 1

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

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Coming Soon: IVR System to Offer Prior Authorization Requests for FEP® Members

Starting Oct. 15, you’ll be able to use our interactive voice response (IVR) system to complete some inpatient and outpatient prior authorization requests for FEP members.

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Genetic Testing Prior Authorizations via AIM Submission Tip

When submitting prior authorization requests for genetic testing through AIM Specialty Health® (AIM), please use the resources available on their website. They can help you submit “complete” requests and prevent delays due to incomplete information. As an example, tests submitted as “unknown” cannot be reviewed due to lack of information. Reviewing available resources will provide you with the information needed to submit a complete genetic testing request. For more information on submitting requests through AIM, visit the AIM page on our provider website.


Update to Prior Authorization Codes for Commercial Members, Effective Oct. 1, 2022®

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

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