October 2017

Medicaid

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

Read this month’s Medicaid newsletter to learn about CMS canceling the prescriber enrollment project, 2018 HEDIS^® participation, after-hours service requirements and more.

Fee Schedule Updates Effective Oct. 1

Review the changes that went into effect Oct. 1 that impact Blue Choice PPO^SM, Blue Essentials^SM, Blue Premier^SM, Blue Advantage HMO^SM and ParPlan.

Reminders

• Integration of Prime Therapeutics^® and Walgreens^® Specialty Pharmacy and Mail Order Services
• BCBSTX New Employer Group Plan ? Employees Retirement System of Texas Effective Sept. 1
• Become a BCBSTX HealthSelect^SM of Texas Provider Today

National Drug Code (NDC) Billing Update for Medicare Advantage Claims

Applies to: Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM

Beginning Dec. 15, 2017, BCBSTX will activate new edits that validate NDCs for both Blue Cross Medicare Advantage plans. Details about specific elements, loops, segments and fields are included.

Effective Sept. 15: Changes to Billing and Documentation Information and Requirements

Policy changes related to billing and documentation requirements went into effect Sept. 15, including permissible, pass-through, under-arrangement and all-inclusive billing, and more.

Reminders

• New ClaimsXten^TM Rules Implemented Sept. 18
• New EFT and ERA Information Available Online
• EFT and ERA Update for Non-contracted Medicare Advantage Providers

Update: Prior Authorizations and Referrals for HealthSelect of Texas Participants

To reduce call hold times, BCBSTX recommends using iExchange^® for submission of prior authorizations and referrals for HealthSelect of Texas participants.

Medicare Advantage Preauthorization List Update

Applies to: Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO)

Updated preauthorization lists for both Blue Cross Medicare Advantage networks go into effect Jan. 1, 2018.

Preauthorization and Referral Requirements Lists Are Changing Jan. 1, 2018

Applies to: Blue Choice PPO, Blue Essentials, Blue Essentials Access^SM, Blue Premier and Blue Advantage HMO

Review the three new changes taking place to the preauthorization requirements for various products beginning Jan. 1, 2018.

Antidepressant Medication Management Initiative

Learn about BCBSTX’s goal of increasing antidepressant medication adherence through an initiative that targets specific members. Get suggestions on how to help your patients who are taking these medications.

Update: Texas Severe Weather - BCBSTX Responds to Help Providers

Due to the affects Hurricane Harvey, you and your patients may have questions about eligibility and services. This article provides details about reimbursement payments, how to check eligibility, hours of operation and more.

Update: Special Severe Weather Message for Providers in the HealthSelect Network

Information is available to help HealthSelect providers navigate eligibility and services during the aftermath of Hurricane Harvey

Looking at Variability in Pricing Solutions Through Shared Data

BCBSTX is working to help payers and providers better collaborate on making health care more affordable though programs like Benefits Value Advisor. This program helps members get cost estimates, schedule appointments and assists with benefit preauthorization.

Pediatricians Warning Against Teens Using Marijuana

A recent study says that marijuana is not a benign drug for teens while their brains are developing. Unfortunately, government data shows almost 40 percent of U.S. high school students have tried marijuana. As such, the American Academy of Pediatrics is encouraging pediatricians to screen both pre-teens and teens for substance use.

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 2017 Health Care Service Corporation. All Rights Reserved.

Important Information