January 2023

Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

•	Updates to the Texas Medicaid Provider Website
•	Reminder to Encourage Medicaid Members to Renew Coverage
•	BCBSTX Reprocessing Claims for Recoupment for Nurse Practitioners and Clinical Nurse Specialists
•	Texas Medicaid Claims Editing Enhancements Effective March 6, 2023
•	Updates to STAR Kids Long-Term Services and Supports (LTSS) Billing Update
•	Texas Health Steps (THSteps) Preventive Care Screening Tools
•	Infant and Early Childhood Developmental Surveillance and Screening Components of the Texas Health Steps Checkup
•	Updates to Healthy Texas Women (HTW) and Healthy Texas Women Plus (HTW Plus)
•	Prior Authorization Update for Amvuttra (J0225) Effective Feb. 1, 2023
•	Texas Health and Human Services Commission Policy Flexibility for Member Appeals Ending Jan.31, 2023

Fee Schedule Update for BCBSTX DME, Prosthetic and Orthotics Providers

Effective March 1, 2023, we will implement changes to the maximum allowable fee schedule for in-network BCBSTX Durable Medical Equipment (DME), prosthetic and orthotic providers.

Reminder: Update Your Demographic Information

If you’ve changed your location, phone number, email or other important details, it’s important that you let us know so our members can locate you in our Provider Finder^® tool. We suggest you periodically review yourself in Provider Finder to verify the accuracy of your information. A link to the Verify and Update Your Information page and verification instructions are included.

Updates to ‘Message This Payer’ Option via Availity^® Essentials

In September, we published an article announcing the new Message This Payer option for sending us secure, electronic claim messages. To ensure timely responses, we’ve decided to limit the Message This Payer capability to BCBSTX member claims only. Therefore, this option will temporarily be disabled for BlueCard^® (out-of-area) claims. Our customer advocates remain available for these complex claim inquiries. For more information, refer to the Message This Payer page on our website. As a reminder, Message This Payer is also unavailable for Medicare Advantage for Texas Medicaid claims.

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:

•	Coordinated Home Care/Private Duty Nursing Policy – effective 12/13/2022

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.

Cervical and Breast Cancer Screenings

As you know, regular screenings for cervical cancer and breast cancer can detect problems early when they’re easier to treat. This article provides a recommended screening schedule for both, how to address health disparities and close gaps in care, and tips to consider when talking with your patients about the importance of screenings.

Update to Prior Authorization Codes for Medicare Advantage Members

Effective Jan. 1, an additional change was made to the previously communicated Jan. 1 Prior Authorization List. The change includes the removal of lab codes previously reviewed by eviCore^®.

Home Health Physician Fee Schedule Increase for Medicare Advantage (PPO) Providers

Effective Jan. 1, we added new reimbursement rates to home health providers’ existing Medicare Advantage (PPO) agreement fee schedule. Instructions on how to access fee schedules are included.

Hospitals Must Provide Medicare Outpatient Observation Notice

As a reminder, hospitals and Critical Access Hospitals (CAH) are required to give the standardized Medicare Outpatient Observation Notice (MOON) to our Blue Cross Medicare Advantage^SM members who are under outpatient observation for more than 24 hours. Instructions on how to complete the MOON are included.

Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

If you participate in Blue Cross Medicare Advantage plans, you cannot bill our members enrolled in the Qualified Medicare Beneficiary (QMB) Program, which is a federal Medicare savings program. QMB beneficiaries are not responsible for Medicare Advantage cost-sharing or out-of-pocket costs. Review tips to avoid billing QMB patients.

More Access for Medicare Patients and Providers

If you’re a Medicare provider, you may treat Blue Cross Group Medicare Advantage Open Access (PPO)^SM, UT CARE^TM Medicare PPO  and Blue Cross Medicare Advantage Flex (PPO)^SM members. You may treat these members regardless of your contract or network status with BCBSTX, which means you don’t need to participate in BCBSTX Medicare Advantage networks or in any other BCBSTX networks to see these members. Some requirements apply.

MAPD Risk Adjustment Medical Records Request

As a reminder, Change Healthcare manages medical record retrieval for BCBSTX. They’re currently gathering records for a Centers for Medicare & Medicaid mandated risk adjustment review and for Blue Cross and Blue Shield’s National Coordination of Care Program, which aims to close gaps in care for Blue Cross Group Medicare Advantage (PPO)^SM members.

Expansion of Members Utilizing eviCore for Prior Authorizations for Blue Cross Group Medicare Advantage

Member enrollment in Blue Cross Group Medicare Advantage (PPO) programs growing. Effective Jan. 1, these members will require prior authorization from eviCore healthcare for certain services. Services performed without authorization might not be reimbursed and you may not seek reimbursement from members. A list of prior authorization requirements is included.

bcbstx.com/provider

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