August 2015

(Electronic distribution August 5, 2015)

View a printable PDF of this newsletter.

When Is It Time to Consider Palliative Care?
Although hospice care has existed nationally since the early 1980s, palliative care is a relatively new specialty. Most Americans have never heard of it. In this first of a three-part series, learn about a model of care that focuses on relieving or preventing suffering from “life-limiting illness.”

BCBSTX Implements Changes in Maximum Allowable Fee Schedule
BCBSTX will implement changes in the maximum allowable fee schedule used for Blue Choice PPO^SM, HMO Blue Texas^SM, Blue Advantage HMO^SM (Independent Provider Network and THE Limited Network only) and ParPlan effective Nov. 1, 2015. Get the details.

Medical Record Documentation Reminder
The primary focus of medical record documentation is to communicate a patient’s treatment plan and support continuity regarding their treatment. Accurate and complete documentation is an essential component of patient care that enhances quality. Please take a moment to review proper procedures.

BCBSTX to Host a Payer-specific Overview of the Availity^TM Web Portal
Using a vendor portal to exchange secure patient information during and after the claim submission process can help simplify your operations. Our Provider Education Consultant team is hosting Back to Basics: ‘Availity 101’ webinars, using Availity Web Portal as an example of a vendor who could provide the services.

ClaimsXten^TM System Edit Updates, Effective in June
BCBSTX enhanced the ClaimsXten code auditing tool in mid-June. Get the details on the changes we made to the bundling logic in our claim processing system.

Effective November: Intranasal Topical Anesthetic for Headaches Is Not Covered
In November, we will update our medical policy to state that topical application of anesthetic, with or without steroids, as a nerve block for headaches or facial pain is considered experimental, investigational and is not a covered benefit.

Revised Predetermination Request Form and New Texas Prior Authorization Form
We have revised our Predetermination Request Form for providers who want to request a predetermination to establish medical necessity and available benefits.

Health Care News and Commentary Site Launches
The operator of BCBSTX has launched  a new news and commentary website to convene a discussion on the major issues that face the health care industry today.

Notices and Announcements
In this issue of the newsletter, we discuss point of use convenience kits, ICD-10 preparation, new ClaimsXten outpatient facility rules, a quick guide to member ID cards, our Healthy Family app and a reminder about online claims status through our interactive voice response phone system. 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.

Contact us
View our quick directory of contacts at BCBSTX.

Update your contact information
Accurate provider directories are an important part of providing BCBSTX members with the information they need to manage their health.

To update your contact information, please submit your correspondence via fax to 972-231-9664 or mail to P.O. Box 650267, Dallas, Texas, 75265-0267. You should submit all changes at least 30 days in advance of the effective date of change.

If your specialty, practice information/status or board certification is not correct on the BCBSTX Provider Finder^®, or if you would like to have a subspecialty added, please contact your Network Management office.

In addition, BCBSTX periodically identifies providers who have not submitted claims for a period of one year. We make an effort to contact each provider to confirm their information. If the provider does not respond, we will initiate a network termination. Similarly, BCBSTX will inactivate any tax identification numbers (TINs) under which there have been no claims submitted for a period of one year.

Blue Review is published for Blue Choice PPO^SM, HMO Blue Texas^SM, Blue Cross Medicare Advantage (PPO)^SM, Blue Advantage HMO^SM 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 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.