Behavioral Health Mid-Level Fee Schedule Changes

Applies to: Blue Cross Medicare Advantage (PPO)^SM, Blue Cross Medicare Advantage (HMO)^SM and Blue Cross Medicare Advantage Dual Care (HMO SNP)^SM
Effective Jan. 1, 2024, mid-level providers will see higher reimbursement rates for certain behavioral health services.

Category Removals from eviCore^® and Other Updates to Prior Authorization Codes

Effective Jan. 1, 2024, we are changing our prior authorization requirements for Medicare members to reflect new, replaced or removed codes.

Medicare Advantage Members to Transition to BCBSTX Kidney Care Program

In January, we’re launching a specialized care coordination program for eligible Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) members who have chronic or end-stage kidney disease. Our Kidney Care Program will replace the Somatus kidney care program.

Medicare Advantage Behavioral Health Services Update

Applies to: Blue Cross Medicare Advantage (HMO) and Blue Cross Medicare Advantage Dual Care (HMO SNP)
Effective Jan. 1, 2024, we’ll no longer contract with Magellan^® for behavioral health services. This article has important details about the transition and contracting opportunities, and a reference guide with contacts and resources.

2024 Blue Cross Medicare Advantage^SM Expansion Service Areas

Effective Jan. 1, 2024, our Blue Cross Medicare Advantage (PPO), Blue Cross Medicare Advantage (HMO) and Blue Cross Medicare Advantage Dual Care (HMO SNP) networks are expanding across Texas. The expansion continues to build on strong networks already in place in Texas and is part of our commitment to providing members with access to affordable health care.

Survey Assesses Medicare Advantage Members’ Health Outcomes

The Centers for Medicare & Medicaid Services (CMS) sends a Health Outcomes Survey (HOS) to a sample of our members from August through November. The survey asks members in Blue Cross Medicare Advantage and prescription drug plans to rate their last six months of care. If you get questions from members who have received the survey, please encourage them to respond. The survey covers health care topics our members may discuss with you, such as:

• Maintaining or improving physical health, including managing pain and exercise habits
• Maintaining or improving mental health, including energy levels, mood swings and sleeping habits
• Preventing falls

HOS results identify opportunities to improve health care plans. Results also affect the CMS Star Ratings, which rate Medicare Advantage plans on a scale from one to five stars. Our goal is to achieve the highest possible Star rating for our plans.