Processing claims for preventive colonoscopies

 

Blue Review

A newsletter for physician, professional, facility, ancillary and Medicaid providers

December 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 Jan. 1 MCO enrollment for all LTSS providers, Dec. 31 THMP enrollment, 2018 HEDIS® requirements, the 2017-2018 flu season and more.

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Notices & Announcements

BlueOptionsSM Benefit Plan Design No Longer Offered Beginning Dec. 31, 2017

Effective Dec. 31, 2017, the BlueOptions benefit plan product will no longer be offered as a BCBSTX product. BlueOptions provided enhanced benefits to BCBSTX members who obtained care from Blue Choice PPOSM physicians who were recognized through the BlueCompareSM program for cost efficiency and quality performance. BlueCompare for Physicians, the program that measures quality for certain specialties, will continue to provide performance reporting to physicians and members. Please note that the elimination of this benefit plan does not affect any other networks. If you have questions, please contact your BCBSTX Network Representative.

New Medical Record Retrieval Vendor for BlueCard® Plan Member Records

Effective Jan. 1, 2018, Inovalon® will replace Verscend as the new medical records retrieval vendor. You may receive requests for medical records from both Verscend and Inovalon until the transition is completed on Jan. 1, 2018. For your convenience, we’ve listed all the ways medical records can be submitted to both companies.

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Reminders

Claims & Eligibility

Zero Copay for Preventive Services Reminder

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

Blue Cross Medicare AdvantageSM covers a full range of preventive services to help keep patients healthy, find problems early and determine when treatment is most effective. As such, there are no copays for preventive services for Blue Cross Medicare Advantage members.

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Coverage of Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease

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

Original fee-for-service Medicare will continue covering the cost and reimbursement of SET for symptomatic peripheral artery disease in 2018. For 2019 and subsequent years, providers should plan to bill SET items and services to the beneficiaries’ Blue Cross Medicare Advantage plan unless notified otherwise.

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Processing Claims for Preventive Colonoscopies

Review examples of claims billing for colonoscopies. Also review tips on using modifiers for preventive services and some FAQs about preventive colonoscopies.

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Reminders

 

Clinical Resources

The MagellanSM Connection: Partnering with PCPs to Manage Patients’ Behavioral Health Care Needs

Magellan provides valuable resources and services that can help you improve medical and behavioral outcomes for your patients.

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Reminders

 

Standards & Requirements

Reminder

 

Education & Reference

CMS Guidance Notifications

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

The Centers for Medicare & Medicaid Services (CMS) routinely publishes notifications that provide CMS guidance to all Medicare physicians, providers and suppliers. The notifications also provide guidance to those serving beneficiaries enrolled in Original Medicare and one of the Blue Cross Medicare Advantage (PPO) or Blue Cross Medicare Advantage (HMO) Plans.

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2017 Annual HEDIS and QRS Reports

Through a quality improvement program, BCBSTX measures the care and services received by members from contracted providers. Review our year-to-date HEDIS and QRS reports.

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Working Together to Stop Antibiotic Resistance

BCBSTX is doing its part to the meet the White House goal of reducing inappropriate outpatient antibiotic use by 50 percent by 2020. Are you? When prescribing antibiotics, make sure you discuss appropriate use and side effects.

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Reminder

•  Provider Manual Update

 
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In Every Issue

BCBSTX is required to provide certain notices in all published correspondence with physicians, professional providers, and facility and ancillary providers. For the latest updates, visit the News and Updates area of the BCBSTX provider website. Access this month’s articles.

Printable PDF

View a printable PDF of the non-Medicaid information in this newsletter.

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