October 2016

Special Bulletin

Hurricane Matthew Impacting eviCore healthcare Call Centers

Due to Hurricane Matthew, eviCore healthcare has implemented its business continuity plan and closed its offices in Florida and South Carolina. We expect this to be effective through Friday, Oct. 7. While eviCore is maximizing its use of employees in other locations, we encourage you to use eviCore’s web portal as much as possible. If you need to call eviCore, please keep in mind that there may be longer-than-normal hold times for the next several days.

Claims & Eligibility

Flucelvax Quadrivalent Billing Update

The American Medical Association released CPT^® code 90674 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage), which best describes Flucelvax Quadrivalent – a new flu vaccine for the 2016-2017 flu season. This code will be effective Jan. 1, 2017. Until the effective date, Blue Cross and Blue Shield of Texas (BCBSTX) feels Flucelvax Quadrivalent is appropriately billed with CPT code 90749.

Announcing Changes that will Affect Claims Submissions for Medicare Advantage Plans Effective Jan. 1, 2017

Beginning Jan. 1, 2017, changes will affect claims submissions for our Medicare Advantage plans, including the Payer ID.

Online Portal Applications Help Expedite Administrative Workflows

Learn about Availity^® – a service that can help you conduct HIPPA-compliant transactions online, and also iExchange^® – our online referral and preauthorization tool.

Clinical Resources

2017 Updates to the Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM Preauthorization Lists

Access the updated preauthorization lists of procedures for our Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) plans that go into effect on Jan. 1, 2017.

Notification for Inpatient Admission for Post-stabilization Care Required Within One Business Day for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Members

Learn about the Jan. 1 requirement for a one-day notification of inpatient admission for post-stabilization following the treatment of an emergency medical condition.

Update to Blue Advantage HMO^SM and Blue Advantage Plus^SM HMO Preauthorization/Referral List – Preauthorization Required for Specific Outpatient Surgeries

Review the new preauthorization requirement for a designated list of surgical CPT codes taking effect on Jan. 1, 2017.

New Preauthorization Requirement for Applied Behavior Analysis for Blue Choice PPO^SM Members

Learn about the preauthorization requirement that goes into effect on Jan. 1, 2017, for Applied Behavior Analysis for the treatment of Autism Spectrum Disorder for Blue Choice PPO members.

Coordination of Care Between Medical and Behavioral Health Providers

Learn about available resources to help bridge gaps when communicating treatment and coordination of care plans to your patients.

2015 Continuity and Coordination of Care Report Results, and Recommended Interventions

BCBSTX annually monitors the continuity and coordination of care between Primary Care Physicians (PCP) and specialist providers. Review the opportunities that have been identified to improve communication between PCPs and specialists, and recommendations to improve continuity and coordination of care.

Pharmacy Program

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2016

Review the changes made to the Standard and Generics Plus drug lists that became effective on Oct. 1, 2016.

Updates to the Diabetes Blood Glucose Meter Program

BCBSTX offers certain blood glucose meters to members with diabetes at no additional charge to help them manage their condition. (Note: Members are limited to one glucose meter per year.) However, effective Oct. 1, 2016, there are changes to the types of products offered, as well as how members can obtain one of these meters. Please share this updated information with your patients by directing them to information on the program on our website. Or, you can provide them the member flier (PDF).

Reminder: Pharmacy Benefit Tips

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

Standards & Requirements

eviCore to Pre-certify Outpatient Molecular and Genomic Testing, and Outpatient Radiation Therapy

Beginning Oct. 3, use eviCore healthcare to pre-certify outpatient molecular and genomic testing, and outpatient radiation therapy for Blue Advantage HMO and Blue Advantage Plus HMO members.

Annual Medical Record Data Collection for Quality Reporting begins Feb. 1, 2017

To meet requirements set by the National Committee for Quality Assurance and the U.S. Department of Health and Human Services, BCBSTX will be gathering medical records to collect performance data and satisfy reporting requirements. A BCBSTX representative or a representative from CIOX (third-party vendor) may be contacting your office or facility anytime between December 2016 and February 2017. If you receive a request for medical records, we encourage you to reply within 3 to 5 business days.

Announcing a New Change for Rehabilitative and Habilitative Services for Members Enrolled in QHPs under the Affordable Care Act

Review the change to rehabilitative and habilitative services that takes effect Jan. 1, 2017, for members enrolled in Qualified Health Plans (QHP).

Reminder: Medicare Marketing Guidelines for Providers

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

Education & Reference

Reminder: iExchange^® Now Accepts Electronic Medical Record Attachments

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

Health & Wellness

New Health of America Report Links C-section Rates to Where Members Live

The latest Health of America Report by the Blue Cross and Blue Shield Association provides the results of a data study on the factors driving the use of C-sections by members across the U.S. The results indicate that five markets in Texas made the list of having high rates of C-section births compared to the national average.

Online LifeTimes^® Newsletter Offers Healthy Tips and Insurance Basics

The under-65 LifeTimes member newsletter is now available online. Members can get healthy tips, and benefits and coverage information any time. Be sure to encourage your patients to visit the LifeTimes member website.

BCBSTX Launches ‘Taking on Asthma’ Website

As part of a five-year partnership with the American Lung Association of Texas to enhance care for children with asthma, BCBSTX has launched a “Taking on Asthma” microsite to spread the word about childhood asthma. The site shares information about our initiative, Enhancing Care for Children with Asthma, that aims to improve pediatric asthma care for high-risk patients through community-based interventions. The site also has information and tools for health professionals to better manage and care for children with asthma using the project’s training methods. Learn more about the Enhancing Care for Children with Asthma project and access the resources available for medical professionals.

Notices and Announcements

Provider Training

BCBSTX is proud to offer complimentary educational webinar sessions. These online training sessions give you the flexibility to attend live sessions. Provider billers, utilization areas and administrative departments will benefit from these webinars. Please visit Education and Reference on the bcbstx.com/provider website to view what is available and sign up for training sessions.

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

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