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CLAIMS & ELIGIBILITY |
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NDC Billing Tool on Our Provider Website Is Being Retired
Effective March 1, we’re retiring the National Drug Coding (NDC) Billing Tools for Contracted Providers from our website. Providers will continue having access to the NDC Units Calculator via Availity® Essentials. |
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ClaimsXtenTM Quarterly Update Effective April 15
On or after April 15, we’ll implement our Q1 code updates for the ClaimsXten auditing tool. Code updates may include additions, deletions and revisions to Current Procedural Terminology (CPT®) codes and Healthcare Common Procedure Coding System (HCPCS) codes. |
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Update to Claim Editing Changes for Facility Emergency Department Services
Beginning March 1, 2024, we will edit applicable facility claims to ensure accurate billing and proper reimbursement. This is a change from the original implementation date of Dec. 15, 2023. |
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Notification of Annual Benefit Updates
We update our member files annually with benefit changes. As such, if you need to contact BCBSTX Provider Customer Service, please understand that hold times may be longer than usual at the beginning of the year. As always, we encourage you to obtain your eligibility and benefit information using Availity or your preferred electronic vendor. For patients not scheduled for appointments, deferring eligibility and benefit information requests to a later date is appreciated. |
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Reminder
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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 policy was added or updated:
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EDUCATION & REFERENCE |
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Coding Webinars: Major Depressive Disorder and Annual Wellness Visits
We’re hosting “coding and guidelines” webinars between February and April. Webinars are free to providers and coding professionals. Topics include coding for major depressive disorder, and annual health assessments/wellness visits for Medicare Advantage members. |
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Provider Learning Opportunities
We offer free webinars to contracted providers who service our members. These trainings focus on electronic options and other helpful tools and resources. Review upcoming training sessions on our Provider Training and Continuing Education page. Also, if you are a new provider or have new staff, please refer to our Provider Orientation Information. |
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HEALTH & WELLNESS |
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Annual HEDIS®/QRS Reports
Because we aim to improve the care our members receive, we’re providing a chart that summarizes how we’re performing on selected Healthcare Effectiveness Data and Information Set and Quality Rating System measures, along with key interventions and key accomplishments. |
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Supporting Healthy Hearts
During wellness visits, we encourage you to talk with our members about reducing and managing their risk for heart disease and stroke. As such, we’re providing resources to help you discuss the topic and materials you can share with them. |
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Consumer Assessment of Healthcare Providers and Systems, and Qualified Health Plan Enrollment Experience Surveys
We conduct CAHPS® and QHP enrollment experience surveys every year to monitor our members’ experiences and satisfaction with our contracted providers. The surveys are mailed in February/March to randomly selected members. Review what you can do to improve survey results. |
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Managing Antidepressant Medication
By managing patients’ antidepressant medication, you can help increase medication compliance, monitor side effects and improve treatment outcomes. We’re providing tips and resources to help. |
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MEDICARE ADVANTAGE PLANS |
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Prior Authorization Code Updates for Medicare Advantage Members Effective April 1
We’ll soon change our prior authorization requirements for Medicare Advantage members to reflect new, replaced or removed codes due to updates from our Utilization Management team or the American Medical Association. |
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MEDICAID |
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Access all 2023 and 2024 news and updates for BCBSTX Medicaid (STAR), STAR Kids and CHIP providers. |
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NETWORK PARTICIPATION |
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Reminder: Update Your Demographic Information
If you’ve changed your location, phone number, email or other details, it’s essential that you let us know so our members can locate you in our Provider Finder® tool. We suggest you periodically review yourself on Provider Finder to verify the accuracy of your information. A link to the Verify and Update Your Information page and verification instructions are included in the article. |
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PHARMACY |
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Pharmacy Program Quarterly Update, Part 2: 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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Introducing Smart RxAssist via HealthSmartRx®
A reminder that effective Oct. 16, 2023, eligible TRS participants have access to Smart RxAssist, which helps with enrollment in pharmaceutical manufacturer copay assistance programs. Also, effective May 1, 2024, Keytruda will be added to the provider-administered specialty drug list. |
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PRIOR AUTHORIZATION |
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Update to Prior Authorization Code Changes for Commercial Members Effective April 1
In addition to the code changes already announced for April 1, 2024, the following change is being added: Addition of gene therapy codes to be reviewed by BCBSTX for certain member plans. |
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STANDARDS & REQUIREMENTS |
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Blue Cross and Blue Shield Federal Employee Program® HEDIS Records: Collecting February Through April 2024
We may soon ask your practice for some of our members’ medical records to ensure our compliance with Federal Employee Health Benefits Program requirements. We appreciate your prompt response. |
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UTILIZATION MANAGEMENT |
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Utilization Management: Avoid Delays and Denied Claims
Before rendering care or services to our members, always check their eligibility and benefits first via Availity or your preferred web vendor. This step verifies membership and coverage status, and provides prior authorization requirements. |
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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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