August 2016

Pass-through Billing

Blue Cross and Blue Shield of Texas (BCBSTX) does not permit pass-through billing. Pass-through billing occurs when the ordering physician, professional provider, facility or ancillary provider requests and bills for a service, but the service is not performed by the ordering physician, professional provider, facility or ancillary provider.

Pharmacy Program Updates: Quarterly Pharmacy Changes, Effective July 1, 2016

Review the changes made to the Blue Cross and Blue Shield of Texas (BCBSTX) Standard drug list and Generics Plus drug list that became effective on July 1, 2016.

Reminder: New Preauthorization Requirements through eviCore

Beginning Oct. 3, 2016, eviCore healthcare, an independent specialty medical benefits management company, will begin managing pre-service authorization for some specialized clinical services.

Reminder: Corrected Claim Request Change, Effective July 11, 2016

As a reminder, effective July 11, 2016, corrected claim requests for previously adjudicated claims must be submitted as electronic replacement claims, or on the appropriate professional (CMS-1500) or institutional (UB-04) paper claim, and Claim Review form.

Reminder: Use the Correct ‘Place of Service’ Codes When Billing

To expedite claims efficiently, it’s important to submit bills with the correct “place of service” code. Also, patient eligibility and benefits should be checked prior to each scheduled appointment. Ask to see each member’s Plan ID and a photo ID. Lastly, when services might not be covered, the member should be notified.

Quality Improvement Program Available to Providers

Learn about BCBSTX’s Quality Improvement program that focuses on preventive health, behavioral health, patient safety and condition management.

Preventive Care, and Medical and Behavioral Health Clinical Practice Guidelines

Access BCBSTX’s Preventive Care, and Medical and Behavioral Health Clinical Practice Guidelines. Preventive Care Guidelines include recommendations for age and gender-specific preventive care services for infants, children, adolescents, adults and perinatal care. Medical and Behavioral Health Guidelines include information about asthma, cardiovascular disease and more.

CDC Guidelines for Prescribing Opioids for Chronic Pain

Part 2 of a 3-part Series: Determining When to Initiate or Continue Opioids for Chronic Pain

The Centers for Disease Control and Prevention issued new recommendations for prescribing opioid medications. These recommendations are in response to an increased need for provider education due to a nationwide epidemic of opioid overdose and opioid use disorder. In Part 2, we provide information about opioid selection, dosage, duration, follow-up and discontinuation.

The Operator of BCBSTX Named One of America’s Most Community-minded Companies

The Civic 50 has honored us for our work to improve health and wellness in our local communities. The Civic 50 measures corporate civic engagement, and recognizes companies that incorporate socially responsible practices and community leadership into their culture.

Notices and Announcements

BCBSTX Announces New PPO Contracted Air Transportation Provider for Members

Alacura Medical Transportation will become a BCBSTX PPO contracted air transportation provider on Aug. 1, 2016. Alacura will provide scheduled, non-emergency medical transportation from provider to provider (including connecting ground transportation) for Texas PPO group members.

Remittance Viewer Webinars

Learn more about how Remittance Viewer offers providers and billing services convenient access to claims information in several webinars being offered in August.

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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

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