May 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 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.

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.

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.

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

• Rescheduled Implementation Date of Additional Code-auditing Software

Changes to the 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
As previously communicated, BCBSTX has contracted with eviCore to provide Utilization Management services for some new preauthorization requirements. A correction has been made to the preauthorization list, which will be effective June 1, 2017.

Multiple Online Enrollment Options Available in Availity^TM

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.

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.

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.

Reminder

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

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
Continuing our effort to help you commit to our 2017 CRC screening goal, this final article identifies actions you can take to make a positive increase in the number of CRC screenings received by members ages 50-75.

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.

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an Independent Licensee of the Blue Cross and Blue Shield Association

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