September 2016

Pharmacy Benefit Tips

Review how to ensure appropriate utilization of prescription drugs through formulary management, benefit design modeling, specialty pharmacy benefits and clinical programs.

iExchange^® Now Accepts Electronic Medical Record Attachments

Learn about the new secure, online alternative to faxing your patients’ protected health information.

Online Claim Status Available: Availity^® Claim Research Tool

As a reminder, as of July 13, 2015, Blue Cross and Blue Shield of Texas (BCBSTX) Customer Service no longer assists with general claim status inquiries. BCBSTX supports electronic options as the most convenient, efficient and secure method of requesting claim status information for providers, health care professionals and billing agencies.

Implantable Device Vs. Medical Supply/Material

Review definitions and examples of implants versus supplies.

CDC Guidelines for Prescribing Opioids for Chronic Pain

Part 3 of a 3-part Series: Assessing Risk and Addressing Harms of Opioid Use

The Centers for Disease Control and Prevention (CDC) 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 3, we provide information about assessing risk and addressing the potential harms of opioid use.

Medicare Marketing Guidelines for Providers

Remaining neutral when assisting people with enrollment decisions is essential. Review a list of “Do’s” and “Don’ts” for contracted providers from Centers for Medicare & Medicaid Services.

Health Information and Vulnerable Populations: Q&A With Dr. Esteban Lopez

Efforts to make health care accessible and effective face special challenges among those with low-income, people whose first language isn’t English and the uninsured. In this interview with the health care consulting firm Oliver Wyman Health, Dr. Esteban Lopez, Blue Cross and Blue Shield of Texas Chief Medical Officer & Market President, Southwest Texas, explains how community engagement, careful attention to language and cultural differences, and tailored approaches to delivery of care can help overcome those challenges.

Preventing Falls at Home

Staying active, spending time with friends and family, participating in hobbies and exercising regularly helps us all stay healthy. And staying healthy helps us stay living in our own homes as long as possible. Read some key ways to help prevent falls at home.

Reminder: Pass-through Billing Not Permitted

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.

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: 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.

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

Review the changes made to the BCBSTX Standard drug list and Generics Plus drug list that became effective on July 1, 2016.

Notices and Announcements

BCBSTX Announces New PPO Contracted Air Transportation Provider for Members

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

Remittance Viewer Webinars

Learn how the remittance viewer offers providers and billing services convenient access to claims information, and how to how to gain access. Also sign up for a webinar to learn how to maximize the remittance viewer’s functions.

bcbstx.com

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 2016. Health Care Service Corporation. All Rights Reserved.

Important Information