Notices and Announcments

ICD-10: Put Your Claims to the Test
It’s time to face the facts: The transition to ICD-10 is happening. There’s a lot you need to do to prepare, and no one can do it for you. Blue Cross and Blue Shield of Texas (BCBSTX) is nearing completion of updates to all applicable systems in preparation for the wide variety of scenarios that may occur related to processing of ICD-10 codes. Testing is critical to help identify possible issues so they can be fixed well before the Oct. 1, 2015, ICD-10 compliance date.

If you are interested in testing your electronic claims with us, please contact your assigned Network Management Representative. Or, send an email to icd@bcbstx.com – please include “ICD-10 TESTING REQUEST” in the subject line of your email. Provider ICD-10 testing at BCBSTX started in May 2015 and we want to start testing with you.

How Will ICD-10 Impact Your Practice?
The transition to ICD-10 is huge! It will affect all aspects of your practice. For a visual representation of the potential impact to various departments in a provider office, refer to the Provider Office Changes Map. Also visit the ICD-10 page in the Standards and Requirements section of the BCBSTX provider website for additional information and related resources.

Venipunctures for Hospitals and ASCs
Effective Sept. 1, 2015, BCBSTX will no longer pay a separate fee for CPT codes 36415 and 36416 for hospitals and ambulatory surgery centers (ASC). This change affects all BCBSTX commercial business, including all existing and future commercial networks. Currently, this includes Blue Choice PPO^SM, HMO Blue Texas^SM, Blue Advantage HMO^SM and ParPlan.

Blue Advantage HMO
Blue Advantage HMO has no out-of-network benefits.  As such and for all provider types, except for emergency services, claims will be denied for any out-of-network services for which Blue Advantage HMO has not approved an out-of-network referral.

Claim Status No Longer Available Through Automated Phone System, Effective July 13
As noted in last month’s Blue Review and also on our provider website, effective Monday, July 13, claim status will no longer be available via the BCBSTX Interactive Voice Response (IVR) phone system. BCBSTX Customer Advocates will remain available to assist your office with claim adjustments; however, document control numbers (DCNs) – claim numbers – will be required.

We encourage you to prepare now for this change. Rather than calling BCBSTX and using the IVR, you or your billing service will need to conduct online claim status requests (ANSI 276 transactions) using an electronic vendor portal, such as Availity^TM. Conducting online claim status requests will give you real-time responses with detailed results, such as received date, processed date, adjudication outcomes and finalized dollar amounts.

If you are a registered Availity Web Portal user, you also have access to additional online tools at no cost, such as the Claim Research Tool, which offers enhanced claim status information in a user friendly format. Results can be saved electronically or printed for your records.

For More Information
To learn more about the Claim Research Tool and other electronic options available to providers, visit the Education and Reference/Provider Tools section of our website at bcbstx.com/provider. Also watch the News and Updates on our Provider website for dates and times of upcoming webinars. If you have questions or need assistance, email our Provider Education Consultants at pecs@bcbstx.com.

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 independent 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.