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BEHAVIORAL HEALTH |
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Training Resources for Behavioral Health Care
It’s well documented that patients often rely on primary care physicians for behavioral health care. And according to the Health Resources and Services Administration, more than 120 million Americans live in areas experiencing a shortage in behavioral health care providers. So, in this article, we’re providing resources that providers across disciplines may find helpful to support patients presenting with behavioral health concerns. |
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Reminder
- New Enhancements for Behavioral Health Prior Authorizations
Just a reminder that we are making enhancements to our Behavioral Health request and review processes for some commercial members. Read our previous article for details on these ongoing enhancements.
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CLAIMS & ELIGIBILITY |
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New BlueApprovRSM Tool Expedites Prior Authorization and Recommended Clinical Reviews for Behavioral Health Services
The new BlueApprovR tool (in Availity®) continues to streamline the prior authorization and recommended clinical review process by expediting approvals for behavioral health (in addition to medical and surgical services). |
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TRS Hospital Claim Analysis as Required by House Bill
As a result of the Texas legislature passing the General Appropriations Act (House Bill 1), which directs TRS to complete a review of hospital claims that exceeded $100,000 (during the 2022 state fiscal year), you may receive a formal medical records request from us, on behalf of TRS, requesting medical and billing records for identified claims. |
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See Updates to Claim Editing Changes for Emergency Department Services
We’re changing our claims editing and review process for facility and professional claims to ensure accurate billing and proper reimbursement. |
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Reminders
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CLINICAL RESOURCES |
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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. We may add and modify clinical payment and coding policies. The following policies were added or updated:
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Reminder
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EDUCATION & REFERENCE |
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Chronic Kidney Disease Management Strategies for Primary Care Providers
Earn CME credit (at no cost to you) for each module in a 12-part series on chronic kidney disease management strategies. Topics include slowing CKD progression, blood pressure management, evaluation and diagnosis, and more. |
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Reminder
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HEALTH & WELLNESS |
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To support quality care, we provide information to providers and members to encourage discussions on health topics. Watch for more about health care quality in our website’s News and Updates section and our Delivering Quality Care web page. |
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Encourage Annual Eye Exams for Members with Diabetes
As you know, people living with diabetes are at a higher risk of vision loss and eye diseases, yet according to the CDC, 60% of people with diabetes don’t get an annual eye exam. As such, we’re providing tips to help you discuss the importance of eye exams with your diabetic patients. |
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Colorectal Cancer Screenings Goal: 80% in Every Community — ‘Pulling It All Together’
This is the final article in a four-part series about colorectal cancer screenings. Please review the actions you can take to make a difference in increasing the number of people getting colorectal cancer screenings. |
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Reminders
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MEDICARE ADVANTAGE PLANS |
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Medical Records Reminder for Out-of-Area Medicare Advantage Members
If we need medical records for Blue Cross Group Medicare Advantage (PPO)SM members, you will receive requests from Blue Cross and Blue Shield of Texas or our vendor, Change Healthcare, as part of the Blue Cross and Blue Shield National Coordination of Care program. In addition, you may receive requests from EXL Health for select inpatient, diagnosis-related group claims for any out-of-area Blue Cross Medicare AdvantageSM members. Please respond promptly to our requests so that we can provide timely service to those Medicare Advantage members. |
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Reminders
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NETWORK PARTICIPATION |
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Reminder
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PHARMACY |
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Pharmacy Program Quarterly Update, Part 1: Changes Effective Jan. 1, 2024
Review important pharmacy benefit reminders, drug list and dispensing limit changes, and Utilization Management program changes. |
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PRIOR AUTHORIZATION |
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New CPT® Codes for COVID-19 Vaccines and Vaccine Administration
In the last few months, the American Medical Association updated COVID-19 vaccine coding guidance. New codes have been added and some codes are no longer FDA-authorized. |
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Federal Employee Program (FEP®) Updates to Prior Approval Requirements and Benefits
Review the changes going into effect Jan. 1, 2024, for some FEP policies. |
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Reminders
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STANDARDS & REQUIREMENTS |
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Fee Schedules Update Effective Feb. 1, 2024
Effective Feb. 1, we’re implementing changes in the maximum allowable professional and ancillary fee schedules for:
- Blue Choice PPOSM
- Blue EssentialsSM (including HealthSelectSM of Texas Network)
- Blue PremierSM
- Blue Advantage HMOSM
- Blue High Performance Network®
- MyBlue HealthSM
- PAR Plan networks (collectively referred to as "Networks")
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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 articles .
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.
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Printable PDF
View a printable PDF of the non‑Medicaid information in this newsletter.
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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. You can download other tools and learn more about accessibility at adobe.com  .
By clicking this link, you will go to a website/app (“site”). The site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. Some sites may require you to agree to their terms of use and privacy policy.
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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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1001 E. Lookout Drive, Richardson, TX 75082
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