March 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 the delay in changes to therapy reimbursement and changes to the prior authorization process, a network participation opportunity and more.

Reminder

• Additional Code-auditing Software Scheduled for May 7, 2017, Implementation

PCS Paper Mailing Discontinuance: Effective Date Delayed; Attend Reporting On-Demand Webinar

The date to discontinue mailing paper Provider Claim Summaries (PCS) has been pushed from March 1, to a later date in 2017. We will provide information when the date has been determined. As a reminder, you have access to Reporting On-Demand, which allows you to view, print and download PCSs. Complimentary webinars are available in March to learn more.

Register for March Claims Training Classes

BCBSTX is proud to offer complimentary online educational webinars. These sessions give providers, billers, utilization areas and administrative departments the flexibility to attend live webinars. Visit the Education and Reference section on the bcbstx.com/provider website to view available classes or you can check the links below for currently available sessions.

• Back to Basics: Availity^TM 101 Webinar - includes training on Claim Research Tool
• Reporting On-Demand: Obtaining Provider Claim Summaries
• Remittance Viewer

Reminder

• Availity Claim Research Tool Offers Enhanced Status Results

New Preauthorization Requirements through eviCore^TM Effective June 1, 2017

Applies to: Blue Cross Medicare Advantage HMO^SM and Blue Cross Medicare Advantage PPO^SM
Beginning June 1, eviCore healthcare will provide new utilization management preauthorization requirements for some specialized clinical services. Get a list of services and learn about two options to obtain preauthorization through eviCore.

Medicare Outpatient Observation Notice (MOON) Requirement

Applies to: Blue Cross Medicare Advantage HMO and Blue Cross Medicare Advantage PPO
You are now required to provide the MOON to a Medicare beneficiary or enrollee who has been receiving observation services as an outpatient for more than 24 hours.

New BCBSTX Client in Blue Essentials^SM Network: Employees Retirement System of Texas (ERS)

BCBSTX has been awarded the ERS contract, which goes into effect on Sept. 1. Find out how to contract with the Blue Essentials network.

BlueCompare^SM Evaluation on Physicians Is Underway

BlueCompare is a component of the online Provider Finder^® tool that adds quality-related and cost efficiency performance information about participating physicians in the PPO networks. This year’s evaluation has started, and affected physicians will receive a letter with instructions for accessing their performance reports.

Preventive Care Guidelines Available

As a reminder, the 2016-17 BCBSTX Preventive Care Guidelines are available for your reference. They offer guidelines to improve provider awareness and compliance with effective clinical preventive care, improve patient education and increase the percentage of members who receive recommended clinical preventive care services.

Overcoming Barriers to Colorectal Cancer Screenings

The third of a four-part series regarding colorectal cancer (CRC) screenings
Continuing our effort to help you commit to our 2017 colon cancer screening goal, this article identifies potential CRC screening barriers and ideas to assist in overcoming those barriers. We hope these ideas will help you better understand how to overcome patient concerns.

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