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For Providers
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May 2025 |
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MAY SPOTLIGHT |
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Reinforce Prenatal and Postpartum Care to Support Whole Health
We track quality measures related to our members’ care visits and depression screening during and after pregnancy. Review tips to close gaps in care.
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BEHAVIORAL HEALTH |
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Behavioral Health Documentation to Be Reviewed for Medicaid Members
Medical record documentation standards help ensure quality care. Learn what information may be requested or reviewed through electronic health records.
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CLAIMS AND ELIGIBILITY |
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Take Note of Prior Authorization Changes for Commercial and Government Programs
Effective July 1, 2025, prior authorization requirements for certain plans are changing to reflect new, replaced or removed codes. Learn about the changes for:
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• Commercial
• Medicaid
• Medicare Advantage
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EDUCATION |
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Explore Learning Opportunities
We offer free training for providers who participate in our networks. Sign up for sessions, including coding webinars that offer continuing education units.
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MEDICAID |
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PEMS Updates to Allow Provider Credentialing
Beginning May 30, 2025, the Provider Enrollment and Management System will be enhanced to streamline the process for Texas Medicaid enrollment and credentialing with Blue Cross and Blue Shield of Texas.
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Attend a Medicaid Provider Advisory Group Meeting in June
We invite you to join us in the Central and Travis service delivery areas to discuss information sharing, quality improvement and more. Learn how to attend.
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Review First Quarter HCPCS Updates for Texas Medicaid
The Texas Medicaid & Healthcare Partnership implemented the first quarter 2025 Healthcare Common Procedure Coding System additions, revisions and discontinuation. The updates are effective for dates of service on or after April 1, 2025.
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Stay Updated on Medicaid News
You can find information for STAR, STAR Kids and CHIP in Medicaid News and Updates.
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PHARMACY |
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Pharmacy Program Quarterly Update – Part 2
Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.
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STANDARDS AND REQUIREMENTS |
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Learn about Updates to Clinical Payment and Coding Policies
We regularly add and modify our CPCPs as part of our ongoing policy review. See which policies were updated and when.
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Review Medical Policy Updates
Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.
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a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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