Blue Review - Blue Cross and Blue Shield of Texas

April 2016

(Electronic distribution April 6, 2016)

View a printable PDF of this newsletter.

Insurers Now Required by CMS to Conduct Audit for ACA's Risk Adjustment Program
Beginning in 2016, Blue Cross and Blue Shield of Texas (BCBSTX) will be asking for your cooperation and participation in the CMS-required Initial Validation Audit. Learn more.

ClaimsXten^TM 1st Quarter 2016 Updates and Age-specific Code Replacement Rule Implementation
BCBSTX reviews new and revised Current Procedural Terminology and HCPCS codes on a quarterly basis. Codes are periodically added to or deleted from the ClaimsXten code auditing tool software. Get the details.

HMO Plans - Importance of Obtaining a Referral and/or Preauthorization and Admitting to a Participating Facility as a Network Provider
HMO Blue Texas^SM, Blue Advantage HMO^SM and Blue Premier^SM members require a referral from their PCP before receiving services from a specialty care physician or professional provider (except for OBGYNs). The referral must be initiated by the member's PCP, and must be made to a participating physician or professional provider in the same provider network. Learn more.

Importance of Obtaining Preauthorization for Initial Stay and Add-on Days
Preauthorization is required for certain types of care and services. It is the responsibility of the insured person to confirm that their physician or professional provider obtains preauthorization for services requiring preauthorization. Learn more.

Implantable Device Versus Medical Supply/Material
We have received a number of questions from providers about billing for implants. To help address the topic, we have provided a reminder about the National Uniform Billing Committee definition of an implant. Get the details.

Notices and Announcements
In this issue of the newsletter, learn more about how remittance viewer offers providers and billing services convenient access to claims information. Get the details.

In Every Issue
BCBSTX is required to provide certain notices in all published correspondence with physicians and professional providers. For the latest updates, visit the News and Updates area of the BCBSTX provider website. Get started now on reviewing this month's articles.

Update Your Contact Information
Accurate provider directories are an important part of providing BCBSTX members/subscribers with the information they need to manage their health. If any of your information has changed, please update your contact information.

Blue Review is published for Blue Choice PPO^SM, HMO Blue Texas^SM, Blue Cross Medicare Advantage (PPO)^SM, Blue Advantage HMO^SM, Blue Premier and ParPlan contracting physicians and other health care providers. Ideas for articles and letters to the editor are welcome; email BlueReviewEditor@bcbstx.com.

The information provided in Blue Review does not constitute a summary of benefits, and all benefit information should be confirmed or determined by calling the customer service telephone number listed on the back of the member/subscriber ID card.

BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent, third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or services they offer. If you have questions regarding any of the products or services mentioned in this periodical, please contact the vendor directly.

Blue Cross^®, Blue Shield^® and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

BCBSTX makes no endorsements, representations, or warranties about any products or services offered by
independent third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or
services offered by them. If you have any questions about the products or services mentioned in this newsletter,
contact the vendor directly.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

Blue Review • April 2016 • www.bcbstx.com