Provider Webinars Scheduled for 2018
A newsletter for physician, professional, facility, ancillary and Medicaid providers |
January 2018
Medicaid
Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids & CHIP Providers
Read this month’s Medicaid newsletter to learn about reimbursements for CHIP services, THSteps procedures and documentation, private duty nursing policy clarification, free value-added services and more.
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Notices & Announcements
Provider Webinars Scheduled for 2018
Billers, utilization areas and administrative departments should attend the upcoming 2018 complimentary educational webinars. Topics include: AvailityTM 101, iExchange® and remittance viewer.
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Update to the Durable Medical Equipment/Prosthetics and Orthotics Fee Schedule, Effective Dec. 1, 2017
Review the updates made to the Durable Med Equipment/Prosthetics & Orthotics fee schedule.
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Reminder: BlueOptionsSM Benefit Plan Design No Longer Offered Beginning Dec. 31, 2017
Since Dec. 31, 2017, the BlueOptions benefit plan product is no longer offered as a BCBSTX product. BlueOptions provided enhanced benefits to BCBSTX members who obtained care from Blue Choice PPOSM physicians who were recognized through the BlueCompareSM program for cost efficiency and quality performance. BlueCompare for Physicians, the program that measures quality for certain specialties, will continue providing performance reporting to physicians and members. Please note that the elimination of this benefit plan does not affect any other networks. If you have questions, please contact your BCBSTX Network Representative.
Reminder
Claims & Eligibility
Reminders
- Zero Copay for Preventive Services Reminder
- Processing Claims for Preventive Colonoscopies
- MAO Coverage of Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease
- Find BCBSTX Resources in Availity Payer Spaces
- Reimbursement Percentage Update for Modifier 52
- Government Programs: 835 Electronic Remittance Advice Update
- National Drug Code Billing Update for Blue Cross Medicare AdvantageSM Claims
- New EFT and ERA Information Available Online
Clinical Resources
Annual Medical Record Data Collection for Quality Reporting Begins Feb. 1, 2018
HEDIS® season is upon us. A representative from BCBSTX or from our contracted vendor, CIOX, may be contacting your office between February and May to work out details for collecting medical records. Cooperation with the collection of HEDIS and QRS data are required under the providers’ contractual obligation. We appreciate your time and effort to help us meet the HEDIS requirements.
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Behavioral Health Program Changes for Boeing Members, Effective Jan. 1, 2018
BCBSTX is now administering Boeing plan members’ behavioral health benefits.
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Skilled Nursing Facility (SNF) Benefit Change for Federal Employee Plan (FEP) Members
Beginning Jan. 1, 2018, senior patients with an FEP Standard Option health plan who are not enrolled in Medicare Part A, but need rehabilitation that a nursing home does not offer, will be covered for up to 30 days per benefit year of inpatient SNF care.
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Preventive Care Guidelines Are Available
The 2017-18 Preventive Care Guidelines are available. Each year, BCBSTX reviews the recommendations made by several professional organizations to update the Preventive Care and Wellness Guidelines related to preventive care, health screenings and immunizations.
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Reminders
- The MagellanSM Connection: Partnering with PCPs to Manage Patients’ Behavioral Health Care Needs
- Requesting Predetermination of Benefits
- Preauthorization and Referral Requirements Lists Changed Jan. 1, 2018
- Blue Cross Medicare Advantage Preauthorization List Update
- Know the Requirements for Preauthorization/Prior Authorization Rules and Retrospective Reviews for Medical Necessity
Pharmacy Program
Pharmacy Benefit Tips
Learn strategies you can use to help our members – your patients – use prescription drugs appropriately.
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Standards & Requirements
Reminder
Education & Reference
Reminders
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