Quarterly Pharmacy Changes Effective April 1, 2018


Blue Review

A newsletter for physician, professional, facility, ancillary and Medicaid providers

May 2018


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 Mental Health Awareness Month, how home health providers can keep the cash flowing, the transition from MEDsys to Datalogic, reducing credentialing burdens and more.

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Notices & Announcements

Annual Rights and Responsibilities Notification

The following article details your rights as a BCBSTX practitioner, member rights and responsibilities, care management programs, utilization management decisions and pharmacy benefits.

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Focus on Behavioral Health

May 10 Behavioral Health Provider Education Session

In just four days, join us for a behavioral health training session that will cover medical necessity criteria, coordination of care, case management, utilization management and more. RSVP by Tuesday, May 8.

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May Is Mental Health Awareness Month

Early engagement and interventions are crucial for improved mental health outcomes. As such, access the Magellan Healthcare® Behavioral Health Toolkit for the information to make behavioral health referrals and assessments.

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Video Series: Blue PromiseSM – Depression and Chronic Conditions

Making The Health Care System WorkDepression can impact chronic diseases and other medical conditions in many ways. In this Blue Promise video, BCBSTX president, Dr. Dan McCoy, talks with Dr. Conway McDanald, BCBSTX’s chief medical officer and vice president of Behavioral Health, about how mental health can impact overall health.


Pharmacy Program

Pharmacy Program Updates: April Drug List and Utilization Management Changes

Review the pharmacy network, drug list, dispensing limit and utilizations management program changes that went into effect April 1, 2018.


Preauthorization Information

ERS Prior Authorization Requirement Update – 491 Outpatient Procedures Removed

Based on provider feedback, 491 outpatient procedures no longer require prior authorization for Employee Retirement System of Texas’ (ERS) HealthSelectSM of Texas or Consumer Directed HealthSelectSM. A list of the procedures being removed is available. All denied claims since Sept. 1, 2017, that include any of the 491 outpatient procedures will be adjusted as appropriate for payment.

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Claims & Eligibility

Modifier 25 and Modifier 59 Frequently Asked Questions (FAQ)

A Modifier 25 and 59 FAQ can be found under Claims Filing Tips - Submitting Claims in the Claims and Eligibility section of the BCBSTX website. The FAQ defines modifiers 25 and 59, provides an effective date for the recent modifier validation in our coding software, and provides information and direction if a provider receives a denial resulting from the modifier review. If you have any questions, please contact your Network Management Representative.

Blue Essentials AccessSM Benefit Plan: No PCP or Referrals Needed

As a reminder, Blue Essentials Access is a plan that doesn’t require BCBSTX members to select a primary care provider or obtain a referral for specialist services when using in-network Blue Essentials providers. See a sample ID card to help identify this open access plan.

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Clinical Resources

Overcoming Barriers to Colorectal Cancer (CRC) Screening

The evidence is clear that CRC screening is beneficial. Still, overcoming barriers may be challenging. This article identifies potential CRC screening barriers and some ideas to help overcome them.

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Network Participation

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.

Standards & Requirements


Education & Reference

Tackling Prescribing Patterns to Combat the Opioid Crisis

Making The Health Care System WorkIs there a way to keep opioids out of the hands of those who don’t legitimately need them? Check out the Tackling Prescribing Patterns to Combat the Opioid Crisis article on our Making the Health Care System WorkSM news portal.

Health & Wellness Tips to Share

BCBSTX’s LifeTimes website has many articles on a range of topics including: bone and joint health, cancer, diabetes, general health, and heart and lung health. Spanish is available.

The Connect Community provides articles, blogs and videos, and visitors can ask questions and get answers. Topics include everything from improving well-being to explaining health coverage. Spanish is available.


Did You Know?

Did You Know (formerly In Every Issue) provides an ongoing collection of articles to assist provider offices with servicing BCBSTX members. Access this month’s articles.

BCBSTX is required to provide certain notices in all published correspondence with physicians, professional providers, and facility and ancillary providers. For the latest updates, visit the News and Updates section of the BCBSTX provider website.

Printable PDF

View a printable PDF of the non-Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

Update Your Information

Do you need to update your location, phone number, email or other important details on file with BCBSTX? Use our online forms to request information changes.


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