August 2017

HHSC Physical, Occupational and Speech Therapy Benefits Changing September 1, 2017

Learn about the changes to these benefits that will affect all ages.

Reminder: Update Regarding Claim Denials for Discharge Status

Blue Cross and Blue Shield of Texas Medicaid (STAR) CHIP and STAR Kids is updating prior notices sent on February 24, 2017. Clean claims submitted with discharge status code 01 and frequency code 1 will be processed. Claims submitted with discharge status code 30, and frequency code 5 or 7 will be denied. Please review the Texas Medicaid and Health Partnership (TMHP) manual for more information on submitting the most appropriate frequency codes.

Reminder: AAPCA Medicaid Benefits Transitioning to Managed Care

Beginning September 1, 2017, individuals currently receiving Medicaid benefits through the Department of Family and Protective Services Adoption Assistance or Permanency Care Assistance (AAPCA) programs will receive their Medicaid benefits through an MCO. MCO means that Medicaid beneficiaries receive their health benefits through a health plan’s network of doctors, specialists and other providers. Medicaid benefits will not change. Medicaid will continue covering doctor’s visits, hospital visits, therapies, specialists, medical equipment and medical supplies. Most AAPCA clients will go into the STAR MCO program. Beneficiaries who receive Supplemental Security Income and/or Medicare will go into the STAR Kids MCO program. AAPCA beneficiaries who receive services through a 1915(c) waiver already transitioned to STAR Kids on November 1, 2016. To learn more, go to hhs.texas.gov/AAPCA.

Reminder: Address Changes for Claims, Appeals and Overpayment Recovery Requests

The address for claims and appeals submissions changed on December 31, 2015. The overpayment recovery address changed on June, 1, 2017.

Electronic Visit and Verification Solution (EVV) Reason Code 305 Revisions

Be sure to review the changes made to EVV Reason Code 305. Failure to document certain information may result in claim denial, recoupment or contract action.

Missed Appointment Tracking

When members miss appointments, providers must document the missed appointment in the member’s medical record. Providers must make at least three attempts to contact the member to determine the reason for the missed appointment. The medical record must reflect the reason for any delays in performing an examination, including any refusals by the member.

Texas Health Steps (THSteps): Periodicity Schedule, Anticipatory Guidance Resource List and More

In THSteps news this month, we encourage you to review the previous changes made to the Periodicity Schedule, communicate the importance of timely well-child and dental visits, check out the Anticipatory Guidance Resource List and send requested medical records for the ongoing THSteps audit.

FQHC Amendment Process Effective September 1, 2017

Learn how BCBSTX is complying with the court order Legacy Community Health v. HHSC, which requires changes to how Federally Qualified Health Centers (FQHC) are paid in Texas.

Medical Record Standards

BCBSTX performs medical record reviews when contracts are signed and every three years thereafter to ensure compliance standards.

Medical Appointment Standards

Primary care providers and specialists must meet standards for appointment scheduling to ensure that members have timely access to medical care and services. BCBSTX monitors provider compliance with appointment access standards on a regular basis.

Language Services Can Help Communication Concerns in Health Care

Help eliminate the overuse of emergency departments, and improve the quality of care your patients receive by providing accurate translation services to your Spanish-speaking patients. Quality improvement strategies should be applied to language services to ensure the ongoing competency of your interpreters.

If you are a newly contracted provider or an existing provider who needs a refresher on one of these subjects, consider attending the following webinars. Please RSVP by the deadline.

Note: If you’re not able to attend any of the trainings below, they are available for completion via Brainshark at your own pace, date and time.