Blue Review - December 2016 | |||
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December 2016 | |||
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Claims & Eligibility Important Changes Impacting Claims Submissions for BCBSTX Medicare Advantage Plans Review the changes taking place for new payer IDs, electronic inquiry submissions, electronic funds transfer payment cycles, electronic remittance advice and more. | |||
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Clinical Resources Reminder: Medical Necessity Review of Observation Services Based on the medical criteria outlined in the Milliman Care Guidelines, it is the policy of BCBSTX to provide coverage for observation services when it is determined to be medically necessary. | |||
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Reminder: 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. | |||
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Reminder: Update to Blue Advantage HMOSM and Blue Advantage PlusSM 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. | |||
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Reminder: 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 requirement for a one-day notification of inpatient admission for post-stabilization following the treatment of an emergency medical condition, effective Jan, 1, 2017. | |||
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Reminder: New Preauthorization Requirement for Applied Behavior Analysis for Blue Choice PPOSM 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. | |||
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Electronic Options Reminder: Enroll Now for ERA and EFT through Availity® Did you know providers can enroll and make necessary changes to the Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) through the Availity web portal? | |||
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Provider Claim Summary Paper-to-Electronic Conversion Coming March 1, 2017 Beginning Dec. 12, a new report viewer application will be available on Availity that will permit you to readily view, download, save and/or print the Provider Claim Summary online, as often as needed. However, beginning March 1, 2017, claim summary information will be delivered through this online report viewer application, rather than distribution via paper mailing; exceptions are available. | |||
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Reminder: Phone System Update for Eligibility and Benefits With the addition of several benefit categories to the Interactive Voice Response phone system, the option for agent assistance will be removed Dec. 12, 2016, for common benefit categories. Also, learn about obtaining eligibility and benefits electronically by joining us for a complimentary Back to Basics: “Availity 101” webinar; three dates in December are available. | |||
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Pharmacy Program Reminder: 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). | |||
Standards & Requirements Reminder: Update to After-hours and Weekend Care Codes Payment Policy BCBSTX is updating its payment policy regarding after-hours and weekend care codes. | |||
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Reminder: Fee Schedule Update for Blue Choice PPOSM and ParPlan for Applied Behavior Analysis and Related Services Review descriptions of the changes made to the fee schedule for applied behavior analysis and related services that go into effect on Feb. 1, 2017. | |||
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Reminder: Physician Payment Policies for Members Enrolled in Blue Cross Medicare Advantage (HMO)SM and Blue Cross Medicare Advantage (PPO)SM BCBSTX is enhancing their review and application of physician payment policies beginning Feb. 1, 2017. | |||
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Reminder: Urinary Drug Test Fee Schedule Update Review a description of the change to the Urinary Drug Tests that begins Feb. 1, 2017. | |||
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Reminder: 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 collecting 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 to February 2017. If you receive a request for medical records, we encourage you to reply within 3 to 5 business days. | |||
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Reminder: 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). | |||
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Notices and Announcements Reminder: HMO Blue TexasSM Name Change to Blue EssentialsSM and Product Update Learn about the name change of HMO Blue Texas to Blue Essentials, and what it means for the network. | |||
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New Health Benefit Plan Blue Essentials AccessSM Offers More Options for Members Learn about the new BCBSTX benefit plan, Blue Essentials Access. This plan is for members who are looking for cost savings, while still having the freedom to choose in-network providers without selecting a primary care physician or obtaining a referral to see a specialist. | |||
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Reminder: Telephonic Medical Services Now Available for Blue Advantage HMO, Blue Advantage Plus HMO, and Blue Choice PPO Fully Insured Members through MDLIVESM Beginning Jan. 1, 2017, MDLIVE, a telehealth provider of online and on-demand health care delivery services and software, will be available to certain BCBSTX members. | |||
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