June 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 MCO and TMHP enrollments, changes to the prior authorization process, the transition of Medicaid benefits, a postpartum depression toolkit and more.

2017 Blue Essentials^SM Benefit Option Highlights

Check out the growing selection of new benefit plan offerings that provide access to the Blue Essentials network. This network increases access to affordable, quality health care services for members in all 254 Texas counties.

Reminder: Medicare Advantage Plans Overpayment Recovery

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

Since Jan. 1, 2017, a new process was implemented for overpayment recovery on claims. Make sure you’re aware of the updated process.

Additional Benefit Categories Contained in IVR Phone System

On June 19, the Interactive Voice Response (IVR) phone system list of common benefit categories will expand. The categories that were added on Dec. 12, 2016, will continue to be included.

Reminder

• Rescheduled Implementation Date of Additional Code-auditing Software

Antidepressant Medication Management Tips

Treating patients who have a major depressive disorder requires strict adherence to treatment plans and careful monitoring of their prescribed medications. Review important tips for discussing treatment options with your patients in need.

eviCore^TM Current and Expanded Preauthorization Requirements

Blue Cross and Blue Shield of Texas (BCBSTX) and eviCore are expanding the services and products that will be handled by eviCore for preauthorization. If you provide these types of services, be sure to check out the details and effective dates.

In-home Colorectal Cancer and Kidney Disease Test Kits Available

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

Select members will have the option to receive FOBT/FIT and MAU in-home test kits for colorectal cancer screening and kidney disease monitoring. Please encourage your patients who receive the kits to use them and to follow the directions to get timely results.

Real-time Preauthorization and Predetermination Notifications

Back in April, we implemented fax notifications of benefit preauthorization and predeterminations to the requesting provider. This enhancement provides real-time information and eliminates the need to check the status of preauthorization or predetermination requests.

BCBSTX New Employer Group Plan – Employees Retirement System of Texas (ERS) Effective Sept. 1, 2017

Review the ERS participant plan options that go into effect Sept. 1. Also, learn how ERS participants are identified and how to obtain prior authorization requirements when needed through eviCore.

Utilization Management Review

As a reminder, medical management at BCBSTX includes utilization management reviews across the continuum of care for both inpatient and outpatient services that are covered services under the member's health benefit plan.

Reminder

• CMS Requires Insurers to Conduct ACA Risk Adjustment Audit
• New BCBSTX Client in Blue Essentials Network: Employees Retirement System of Texas

eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSTX.

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an Independent Licensee of the Blue Cross and Blue Shield Association

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