June 2018

Medicaid

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

Check out this month’s Medicaid newsletter to learn about Electronic Visit Verification transitioning to DataLogic, Post-traumatic Stress Disorder Awareness Month, how to keep the cash flowing, essential aspects of Texas Health Steps and well-child exams, and more.

Provider Finder^® Update

BCBSTX recently updated its Provider Finder tool. It’s important to note changes in the way you use the tool to review your own information and help direct our members to other in-network providers. Review a step-by-step guide to help you navigate the updated Provider Finder.

CMS Requires Insurers to Conduct ACA Risk Adjustment Audit

The Centers for Medicare & Medicaid Services (CMS) will be conducting another Initial Validation Audit. Your direct involvement is essential to its success. It is of utmost importance that you respond to medical record requests in a timely manner.

Reminders

• Annual Rights and Responsibilities Notification
• Avoid Claim Delays – Submitting Documentation Requested from BCBSTX
• Multiple Procedure Payment Reduction for Certain Diagnostic Cardiovascular and Ophthalmology Procedures
• Provider Webinars Scheduled for 2018

June Is PTSD Awareness Month – Get Tips to Help Patients

Post-traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after a variety of traumatic events. Review suggestions and access a toolkit you can use to help your patients cope and recover from PTSD.

New AllianceRx Walgreens Prime E-Prescribing Changes

Review a summary about the changes to submitting electronic prescriptions.

Reminders

• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2018
• BCBSTX Approves Coverage of New Shingles Vaccine Shingrix

Reminders

• ERS Prior Authorization Requirement Update – 491 Outpatient Procedures Removed
• New Preauthorization Requirements for Blue Choice PPO^SM H-E-B Members

Reminders

• Modifier 25 and Modifier 59 Frequently Asked Questions
• Blue Essentials Access^SM Benefit Plan: No PCP or Referrals Needed
• Correction to HMO Plans – PCP Selection and Referral Requirements
• Services Rendered by Providers to Related Members and/or Self

Watch for New CVO Details to Reduce Credentialing Burdens

New and currently contracted professional and facility providers will begin receiving notifications from Aperture^® – a Centralized Verification Organization (CVO) – regarding credentialing events and information about the new common recredentialing date that will be assigned.

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.

Addressing What Matters: How BCBSTX Is Tackling the Opioid Crisis

BCBSTX has launched a new web page called Addressing What Matters, where members and stakeholders can view BCBSTX’s perspectives on emerging health care issues and receive important updates. The web page includes a message from Dr. Esteban López, chief medical officer and Southwest market president, and will feature key topics throughout the year. The inaugural topic focuses on how BCBSTX is addressing the opioid public health emergency.

Opioid-related ER Visits and Hospitalizations on the Rise

In the past decade, opioid-related inpatient hospital stays rose 64 percent across the nation, while emergency room visits nearly doubled. According to data from the Substance Abuse and Mental Health Services Administration, more than 12 million Americans misused prescription opioids in 2015. Read this Making the Health Care System Work^TM article to learn about BCBSTX’s Controlled Substance Integration Program. It collaborates with pharmacists, doctors, case managers and behavioral health specialists to develop a plan of action for members who need help.

Video Series: Blue Promise^SM – Opioid Abuse Epidemic

In this episode of Blue Promise, Dr. Joe McClaran, BCBSTX medical director, defines the dangers of opioid abuse, as well as our programs in Texas that aim to help the situation. Blue Promise is an online video blog that addresses complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, president of BCBSTX.

bcbstx.com/provider

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

1001 E. Lookout Drive, Richardson, TX 75082

© Copyright 2018 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy