April 2018

Medicaid

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

Check out this month’s Medicaid newsletter to read about behavioral health, how accessing provider manuals is now easier, appointment access requirements and improving disparities in oral health.

Behavioral Health: Let’s Talk About It!

In the third quarter of 2017, BCBSTX conducted a survey to gather feedback on the Blue Review newsletter. Many of you asked for more information about behavioral health, and we want you to know that we heard you.

Behavioral Health Provider Education Session

On May 10, BCBSTX will host a training session for behavioral health providers. The training will cover medical necessity criteria, coordination or care, case management/utilization management and more.

Telehealth Brings Behavioral Health Care to People in Need

Virtual visits may improve access to behavioral health services, particularly for people living in areas where there’s limited access to mental health professionals. Check out the Telehealth Brings Behavioral Health Care to People in Need article on our Making the Health Care System Work^SM news portal.

Avoid Claim Delays – Submitting Documentation Requested from BCBSTX

Review how to submit documentation to avoid claim delays. Additional tips are available on our website.

Multiple Procedure Payment Reduction for Certain Diagnostic Cardiovascular and Ophthalmology Procedures

Effective July 1, 2018, certain diagnostic cardiovascular and ophthalmology procedures will be subject to a multiple procedure reduction when done on the same day to the same patient.

Reminder

• Provider Webinars Scheduled for 2018

Pharmacy Program Updates: Network and Drug List Changes

Review the pharmacy network, and drug list changes and updates (including revisions and exclusions) that went into effect Jan. 1, 2018.

Members Save Money with Blue Cross Medicare Advantage^SM Preferred Pharmacies

Help your patients save money by encouraging them to use a preferred pharmacy versus a standard network pharmacy. Some of these pharmacies include: Albertsons^®, H-E-B^® and Walgreens^®. A complete list is available.

BCBSTX Approves Coverage of New Shingles Vaccine Shingrix

BCBSTX now covers two doses of Shingrix administered to patients ages 50 and older. Clinical trials show Shingrix is 91 percent effective over Zostavax^®, which is 51 percent effective. Additional details on our complete, approved immunization schedule are available.

Reminder

• Sensipar^® (cinacalcet) No Longer Separately Reimbursable Under Medicare Part D for ESRD

Correction to HMO Plans – PCP Selection and Referral Requirements

Get a reminder about which plans are included in BCBSTX’s HMO plans. Also review a table that defines when Primary Care Provider (PCP) referrals to specialists are required and when they are not.

Services Rendered by Providers to Related Members and/or Self

Review information about providers rendering medical services to their own family members and themselves.

Reminders

• Availity^TM Claim Research Tool Offers Enhanced Claim Status Results
• Electronic Commerce Services Hours Update; Educational Webinars Available

Keep Your Information Updated to Receive Quick and Accurate Payments

To provide the best service to you and your patients, it's very important that all the information BCBSTX has about your practice is current and accurate. Be sure to let us know about any changes to your practice address, email and/or physician rosters. Keeping us informed of any changes to your information helps us pay your claims more quickly and accurately. It also makes it easier for your patients to get current and correct information on Provider Finder^®. Please update your information by completing the Demographic Change form. Note: Changes may take up to 30 business days to complete. Please consider the impact of your change(s) and the timeliness of your submissions.

New Preauthorization Requirements for Blue Choice PPO^SM H-E-B Members

Access the updated Blue Choice PPO self-insured preauthorization list, which includes a requirement for non-emergent air ambulance services for H-E-B members effective June 1, 2018.

Reminders

• Infusion Therapy Prior Authorization Requirements for ERS HealthSelect^SM of Texas and Consumer Directed HealthSelect^SM Participants
• Blue Cross Medicare Advantage Preauthorization List Update

Medicare Marketing Guidelines

Review the Centers for Medicare & Medicaid Services’ (CMS) annually updated Medicare Marketing Guidelines. They reflect CMS’ interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare prescription drug benefit rules. The guidelines are for use by Medicare Advantage plans, Medicare Advantage Prescription Drug Plans (MA-PDs), stand-alone Prescription Drug Plans (PDPs) and 1876 Cost Plans. The guidelines allow organizations offering both Medicare Advantage and prescription drug plans the ability to reference one document when developing marketing materials.

Reminder

• Provider Payments for Influenza Vaccines for 2017-2018 Flu Season

Reminder

• Quality Improvement Program Information Available to Providers

Video Series: Blue Promise^SM – New Telemedicine Regulations

Your patients now have more choices in how they get medical care quickly. Telehealth rules in Texas have changed to allow more health care delivery via electronic devices. Learn how the modification positively impacts the health of Texans.

Blue Promise is an online video blog with Dr. Dan McCoy, BCBSTX’s president, that addresses complicated health issues with candid conversations from subject matter experts. Feel free to share these videos with your colleagues, staff, patients, friends and family.

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