March 2023

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

•	COVID-19 Vaccine Administration Codes 0164A and 0173A are Now Benefits for Medicaid and CHIP
•	Case Management for Children and Pregnant Women COVID-19 Flexibilities
•	Commonly Missed Observations in Texas Health Steps (THSteps) Well Child Exams
•	Warning: Kids Are Falling Behind on Critical Vaccines
•	Update to Prior Authorization Codes for Medicaid Members, Effective April 1, 2023
•	Update to Age Restrictions for Vaccine Procedure Codes 90671 and 90756
•	New Form for OB/GYN Compliance Challenges with Prenatal Appointment Availability
•	Diabetic Equipment and Supplies Benefit Change for Texas Medicaid Jan. 1, 2023
•	Urgent Request for All Medicaid Recipients to Update Their Contact Information Before March 31
•	Reminder to Encourage Medicaid Members to Renew Coverage

How to Identify UT CARE^TM Members

To support the roughly 30,000 retirees from the University of Texas System, we’re providing ID card reminders, ID card “quick reference” tips and information about verifying benefits.

Verify Your Directory Details Every 90 Days

As a reminder, the Consolidated Appropriations Act (CAA) of 2021 requires that certain directory information be verified every 90 days even if your data hasn’t changed since you last verified it. Under the CAA, we’re required to remove providers from Provider Finder^® if their information isn’t verified. 

Quality Care: Screening for Depression

Screening patients for depression is an important part of outpatient visits. We created a video about depression screening tools, procedure codes and following up on screenings.

Prior Authorization and Claim Reconciliation for Neonatal Intensive Care Unit Services

Beginning April 16, we will start reviewing claims when they are received for Neonatal Intensive Care Unit (NICU) services with the approved services on the prior authorization. This real-time verification will reconcile the claim to the authorization. Examples of claim adjudication are included.

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 policies were added or updated:

•	CPCP003 Emergency Department Evaluation and Management (E/M) Services Coding – Facility Services – Effective Feb. 22, 2023
•	CPCP017 Wasted/Discarded Drugs and Biologicals Policy – Effective May 16, 2023
•	CPCPCP022 Pneumatic Compression Devices – Outpatient Use – Effective May 17, 2023

Closing Gaps in Colon Care

Studies show colorectal cancer is becoming more common in people younger than 50. We’re encouraging providers to discuss screenings and colon health with our members. We’ve created resources that may help.

Cultural Awareness Webinars: Earn Continuing Education Credit

We’re working with Quality Interactions, a separate company that provides cultural awareness training to health care professionals, to provide six webinars at no cost.

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.

Survey to Assess Medicare Advantage Members’ Experiences

The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey is important because it captures members’ experiences with their health care providers, Blue Cross Medicare Advantage^SM plans, and prescription drug plans. As such, we’re providing tips to help improve members’ experiences year-round.

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

We’re changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from our Utilization Management team or the American Medical Association. A summary of changes includes:

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 from Blue Cross and Blue Shield of Texas (BCBSTX) or our vendor, Change Healthcare, as part of the Blue Cross and Blue Shield (BCBS) National Coordination of Care program. Please respond quickly to requests, including those related to risk adjustment gaps and Healthcare Effectiveness Data and Information Set (HEDIS^®) measures.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2023 – Part 1

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

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