Blue Review - January 2017 |
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January 2017 |
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Claims & EligibilityImportant Changes Impacting Claims Submissions for Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM BCBSTX is working to improve efficiencies in 2017. As such, check out new details and resources, and important reminders for claims-related processes. |
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Clinical ResourcesReminder: 2017 Updates to the Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Preauthorization Lists Access the updated preauthorization lists of procedures that went into 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 Make sure you review the requirement that went into effect on Jan. 1, 2017, for a one-day notification of inpatient admission for post-stabilization following the treatment of an emergency medical condition. |
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Reminder: Update to Blue Advantage HMOSM and Blue Advantage PlusSM HMO Preauthorization/Referral List – Preauthorization Required for Specific Outpatient Surgeries Here is a reminder that a new preauthorization requirement for a designated list of surgical CPT codes has gone into effect. |
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Reminder: New Preauthorization Requirement for Applied Behavior Analysis for Blue Choice PPOSM Members A preauthorization requirement went into effect on Jan. 1, 2017, for Applied Behavior Analysis for the treatment of Autism Spectrum Disorder. |
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Electronic OptionsReminder: Enroll Now for ERA and EFT through Availity® 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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Reminder: Provider Claim Summary Paper-to-Electronic Conversion Coming March 1, 2017 A new online report viewer application is now available on Availity that allows you to view, download, save and/or print the Provider Claim Summary online, as often as needed. Beginning March 1, 2017, claim summary information will be delivered through this application, rather than paper mailings. |
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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, please remember that the option for agent assistance was removed last month for common benefit categories. |
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Standards & RequirementsRevised Effective Dates to Fee Schedule Updates for Blue Choice PPO and ParPlan for Applied Behavior Analysis and Related Services Review the new effective dates for some of the changes made to the maximum allowable fee schedule. |
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Reminder: Fee Schedule Update for Blue Choice PPO 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: 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 is 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 three to five 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 took effect Jan. 1, 2017, for members enrolled in Qualified Health Plans (QHP). |
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Reminder: Physician Payment Policies for Members Enrolled in Blue Cross Medicare Advantage (HMO) and Blue Cross Medicare Advantage (PPO) Check out how BCBSTX is enhancing their review and application of physician payment policies that’s beginning Feb. 1, 2017. |
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Notices and AnnouncementsVision Plan Changes to EyeMedSM Vision Care On Jan. 1, 2017, pediatric members (in individual, small group and student health markets) and Blue Cross Medicare Advantage HMO and PPO members transitioned from Davis VisionSM to EyeMed. Affected members were sent letters in November about the change. |
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Virtual Visits Now Available through MDLIVE® for Blue Advantage HMO, Blue Advantage Plus HMO and Blue Choice PPO Fully Insured Members Learn about virtual visits, powered through MDLIVE, and how providers can offer telehealth services to their patients. |
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Reminder: HMO Blue TexasSM Name Change to Blue EssentialsSM and Product Update Don’t forget about the name change of HMO Blue Texas to Blue Essentials. Learn what it means for the network. |
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Reminder: New Health Benefit Plan Blue Essentials AccessSM Offers More Options for Members As published before, Blue Essentials Access 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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Health and WellnessColon Cancer Screenings Goal: 80% Participation by 2018 – Will You Commit? BCBSTX has pledged to have 80 percent of our members between the ages of 50 and 75 screened for colon cancer by 2018. We need your help! Check out some prepared Q&As, and access a free continuing education activity from the CDC for PCPs, nurses, nurse practitioners and clinicians who perform colonoscopies. |
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