Attend a webinar on coding for morbid and severe obesity
A newsletter for physician, professional, facility, ancillary and Medicaid providers |
August 2023
MEDICAID
Access all 2023 news and updates for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers. Highlights include:
NOTICES & ANNOUNCEMENTS
Free Tools & Resources Available via Availity® Essentials
Availity is a secure, web-based, full-service information portal and a claims clearinghouse that provides real-time transactions at no charge.
| Read More |
Reminder: Physician Performance Insight (PPI) Reports are Coming Soon
On or around Aug. 21, PPI reports will be available. Review who should retrieve their reports, how they could impact you and how to request a reconsideration. After PPI reports are posted, our Physician Efficiency, Appropriateness and QualitySM Team will offer PEAQ 101 webinars for physicians to learn more about the program.
Read More
|
BEHAVIORAL HEALTH
Provider Depression Disorder Prescribing
Help close gaps in care for your patients living with depression by reviewing screening and treatment options with them.
| Read More |
Antidepressant Medical Management
Studies show that more than half of patients suffering from major depression don’t take their medications as prescribed. As such, we’re providing a checklist to help you help your patients understand the importance of medication adherence, opportunities for shared decision-making and follow-up appointments.
| Read More |
CLAIMS & ELIGIBILITY
Technical and Professional Components
Modifier 26 denotes professional services for lab and radiological services. Modifier TC denotes technical components for lab and radiological services. These modifiers should be used in conjunction with the appropriate lab and radiological procedures only. Note: When a health care provider performs both the technical and professional services for a lab or radiological procedure, they must submit the total service, not each service individually.
CLINICAL RESOURCES
Statin Therapy for Patients with Cardiovascular Disease and Diabetes
You can help ensure quality care for our members who have cardiovascular disease and diabetes by following guidelines on statin therapy from the National Committee for Quality Assurance.
| Read More |
Clinical Payment and Coding Policy Updates
Our website’s Clinical Payment and Coding Policies 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 and does not address all reimbursement-related issues. During our policy review process, we regularly add and modify clinical payment and coding policy positions. The following policies were added or updated:
EDUCATION & REFERENCE
Webinar on Coding for Morbid and Severe Obesity
Join us for one of two webinars on coding for morbid and severe obesity. Topics include:
| • | Obesity classification levels based on body mass index |
| • | ICD-10-CM guidelines and case studies |
| • | Closing gaps in care for patients |
| Read More |
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 on our website’s News and Updates section and on our Delivering Quality Care web page.
In-Home Test Kits for Colorectal Cancer Screening
FYI: We’re providing in-home Fecal Immunochemical Test kits to certain members who (based on our data) need a colorectal cancer screening. If any of your patients receive a kit, please encourage them to use it.
| Read More |
Colorectal Cancer Screening Options and Statistics: Get the Conversation Started Today
The second of a four-part series on Colorectal Cancer (CRC) Screenings
Almost all major guidelines recommend CRC screenings start for average risk individuals at age 45 and continue through to age 75. But some populations may be reluctant to participate, so we’re providing recommendations to get the conversation started with these patients.
| Read More |
MEDICARE ADVANTAGE PLANS
Update to Prior Authorization Codes for Medicare Members, Effective Oct. 1, 2023
We’re updating our lists of codes that require prior authorization to reflect new, replaced or removed codes. Changes effective Oct. 1 include:
| • | Addition of specialty drug codes |
| • | Addition of lab codes |
| • | Removal of lab codes |
| Read More |
NETWORK PARTICIPATION
Verify and Update Your Information
As a reminder, if you’ve had a change in location, phone number, email or other important details, you must notify us within 90 days via Availity Essentials (under Provider Data Management) or our Demographic Change Form. Your demographic information must be current so our members and other providers can locate you in our Provider Finder® tool.
PHARMACY
Pharmacy Program Quarterly Update, Part 2: Changes Effective July 1, 2023
Review important pharmacy benefit reminders, drug list and dispensing limit changes, and Utilization Management program changes.
|
Read More
|
Introducing Smart RxAssist via HealthSmartRx®
We’re working with HealthSmartRx to implement the Smart RxAssist program for eligible Teacher Retirement System of Texas participants effective Oct. 16, 2023. Learn what Smart RxAssist is, its benefits and how it works.
| Read More |
PRIOR AUTHORIZATION
Update to Prior Authorization Codes for Commercial Members, Effective Oct. 1, 2023
We’re updating our lists of codes that require prior authorization to reflect new, replaced or removed codes. Changes effective Oct. 1 include:
| • | Addition of specialty pharmacy codes to be reviewed by BCBSTX |
| • | Removal of a radiation oncology drug code previously reviewed by Carelon Medical Benefits Management |
| • | Addition of a musculoskeletal joint and spine code to be reviewed by Carelon |
| • | Replacement of genetic testing codes reviewed by Carelon |
| Read More |
|
|
|
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.
|
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, |
1001 E. Lookout Drive, Richardson, TX 75082
© Copyright 2023 Health Care Service Corporation. All Rights Reserved.
Legal and Privacy | Unsubscribe | view in Web Browser