Blue Review – May 2017 | |||
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May 2017 | |||
MedicaidMonthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids & CHIP Providers Read this month’s Medicaid newsletter to register for a Texas Health Steps training in Austin. You can also learn about changes in the prior authorization process for expanded outpatient and specialty utilization management, as well as address changes for claims, appeals and overpayment recovery requests, plus more. | |||
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Claims & Eligibility | |||
Benefit Information Accessible in the Interactive Voice Response (IVR) Phone System We’re providing a list and handy guide of the eligibility and benefit information that's available in the recently updated IVR phone system. | |||
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Changes to the Paper Claim Review Form Process The process of submitting paper Claim Review forms changed Jan. 1, 2017, to more accurately process incoming requests. Do you know what the process changes are? Find out about these changes and get access to three new claim forms. | |||
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Flublok Quadrivalent Billing Update Effective Jan. 1, 2017, the American Medical Association approved the use of Current Procedural Terminology (CPT®) code 90682 (influenza virus vaccine, quadrivalent [RIV4], derived from recombinant DNA, hemagglutinin [HA] protein only, preservative and antibiotic free, for intramuscular use), which best describes Flublok Quadrivalent. Flublok Quadrivalent is for persons 18 years of age and older. Please be aware that Flublok Quadrivalent is not yet accessible for administration. Once available for the 2017-2018 flu season, BCBSTX will cover CPT 90682 when used appropriately. | |||
Reminder | |||
Standards & Requirements | |||
Changes to the New Preauthorization Requirements through eviCoreTM Effective June 1, 2017 Applies to: Blue Cross Medicare Advantage (HMO)SM and Blue Cross Medicare Advantage (PPO)SM | |||
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Electronic Options | |||
Multiple Online Enrollment Options Available in AvailityTM Availity optimizes the flow of information between health care professionals, health plans and other health care stakeholders through a secure, collaborative internet-based exchange. On the Availity Web Portal, providers and other health care professionals can conduct transactions at no charge. Transactions include eligibility and benefits, authorizations and referrals, claims, claim status and remittance with multiple payers. | |||
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Pharmacy | |||
Reminder: Pharmacy Program Benefit Changes Effective Jan. 1, 2017 As a reminder, BCBSTX implemented pharmacy benefit changes for some members with prescription drug benefits administered through Prime Therapeutics®. A summary of the changes sent to affected members is included in the article. | |||
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Notices & Announcements | |||
Clinical Payment and Coding Policies Now Online BCBSTX is now publishing Clinical Payment and Coding Policies on our website. These payment and coding policies describe BCBSTX’s application of payment rules and methodologies for CPT®, HCPCS and ICD-10 coding as applied to claims submitted for covered services. This information is offered as a helpful general resource regarding BCBSTX payment polices and is not intended to address all reimbursement related issues. New policies have been posted and existing policies will be added over time. We regularly adjust clinical payment and coding policy positions as part of our ongoing policy review processes. Check this newsletter and the News and Updates section on our website for newly adapted or revised policies. | |||
Making the Health Care System Work Better, Together Health care is an increasingly complex business. In small and large ways, we are transforming how we support and collaborate with providers, so we can help make the health care system work better for our members. | |||
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Reminder | |||
Health & Wellness | |||
Colorectal Cancer Screenings Goal: 80% Participation by 2018 – Pulling It All Together The final article in a four-part series on Colorectal Cancer (CRC) Screenings | |||
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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. CPT copyright 2017 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly. | |||
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, 1001 E. Lookout Drive, Richardson, TX 75082 © Copyright 2017 Health Care Service Corporation. All Rights Reserved. |