June 2023

Access all 2023 news and updates for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers. Highlights include:

•	Alert: Copays for Some CHIP Services Will Resume Starting Office Visits May 12, 2023
•	Alert: Inactive NPI Numbers in NPPES to Activate Disenrollment Action
•	Alert: Financial Management Services Agency Cost Survey Template Available June 1, 2023
•	Hydroxyprogesterone Caproate (Makena) J1726 No Longer a Benefit, Effective June 1, 2023
•	Electronic Visit Verification Contract Awarded to Accenture and HHAeXchange
•	Reminder: New Form for OB/GYN Compliance Challenges with Prenatal Appointment Availability
•	Reminder: Primary Care Physicians Appointment Accessibility Standard Availability
•	Reminder: Texas Medicaid Providers Help Our Members Get Ready for Redetermination

Medical Policy Updates

We recently changed our Medical Policy page and link, so be sure to update your bookmark to the updated versions.

Language Line Supporting Cultural Competence

We offer translation services for hundreds of languages (to providers and members) free of charge through our Language Line. Learn how it works and save the phone numbers.

Fee Schedule Updates

We will post reimbursement changes and updates for commercial HMO and PPO practitioners in the  Reimbursement Schedules and Related Information section under Standards and Requirements / General Reimbursement Information on our BCBSTX provider website. In-network providers can obtain the password from their Network Management Office.

Changes resulting in a decreased reimbursement will not become effective until at least 90 days from the posting date. We will post the specific effective date for each change. To view this information, visit the General Reimbursement Information section on our BCBSTX provider website.

The Drug CPT^®/HCPCS Fee Schedule is updated quarterly on March 1, June 1, Sept. 1 and Dec. 1 each year. The NDC Fee Schedule is updated monthly.

Reminder:

ClaimsXten^TM Quarterly Update Effective Aug. 21, 2023

We will implement our second and third-quarter code updates for the ClaimsXten auditing tool on or after Aug. 21. Code updates may include additions, deletions and revisions to Current Procedural Terminology codes and Healthcare Common Procedure Coding System codes.

More Outpatient Surgery Codes with Increased Reimbursement When Performed in Ambulatory Surgery Center

Review which additional outpatient surgery services performed at in-network Ambulatory Surgery Centers (for commercial members only) can increase your reimbursements by 15%-50%.

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 and does not 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:

Webinar on Coding for Chronic Kidney Disease

Join us for a webinar on how to code stages and treatments for chronic kidney disease (CKD). The webinar is free to providers and coding professionals. Our Coding Compliance team will present coding information from the official ICD-10-CM Coding Guidelines, the American Hospital Association Coding Clinic and the Centers for Medicare & Medicaid Services. Visit our provider website for more training opportunities.

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.

The Need for Better, Improved Continuity and Coordination of Care

Through our 2022 provider satisfaction survey, we learned there’s been improvement in the overall satisfaction of continuity of care and hospital discharge summaries, but there’s room for improvement. Check out additional satisfaction scores.

Helping Our Members Manage Diabetes

Because you play an essential role in supporting our members living with diabetes, we’re providing tips to close gaps in care.

Colon Cancer Screenings Goal: 80% In Every Community

While the “80% by 2018” national colorectal cancer (CRC) screening campaign brought about progress in reducing CRC, there is still work to do. The “80% in Every Community” strategic plan (2020-2024) provides a variety of activities to use toward achieving 80% CRC screening rates in all communities.

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 BCBSTX or our vendor, Change Healthcare. Please respond quickly to our requests, including those related to risk adjustment gaps and HEDIS measures. Additionally, you may receive requests from CERiS of CorVel Health Corporation for select inpatient diagnosis-related group claims for out-of-area Blue Cross Medicare Advantage^SM members.

Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage

We want to remind you that there are no copays for preventive services for Blue Cross Medicare Advantage (PPO) or Blue Cross Medicare Advantage (HMO)SM. Blue Cross Medicare Advantage covers a full range of preventive services to help keep patients healthy, help find problems early and determine when treatment is most effective. Access the Medicare Learning Network’s Medicare Preventive Services for detailed information.

Medicare Advantage Annual Wellness Visit Resources

We’re providing resources to help you track Medicare wellness visit requirements. As you know, wellness visits provide opportunities to screen for health conditions and manage chronic ones, so please encourage our members to schedule a visit this year if they haven’t already. Note: These resources are optional and you don’t need to return anything to us.

•	Our Annual Wellness Visit Guide has a checklist and information on coverage, coding, preventive services and closing gaps in care.
•	Our Annual Wellness Visit Form  includes sections for members’ medical history, risk factors, conditions, treatment options, coordination of care and advance care planning.

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.

Update to Prior Authorization Codes for Medicare Members, Effective July 1, 2023

Effective July 1, we changed prior authorization requirements for Medicare members to reflect new, replaced or removed codes for:

bcbstx.com/provider

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.

1001 E. Lookout Drive, Richardson, TX 75082

© Copyright 2023 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe  |  view in Web Browser