November 2015

(Electronic distribution November 4, 2015)

BCBSTX Announces New Health Insurance Options for Individuals and Small Businesses
Blue Cross and Blue Shield of Texas (BCBSTX) is introducing its 2016 individual and small group health insurance coverage beginning Nov. 1 in anticipation of the coming open enrollment season. Learn more about the opportunities Texas residents will have to choose coverage options that fits their needs.

Take Advantage of Our Clinical Program Guidelines
Every year we scour the most recent and nationally recognized, evidence-based clinical practice literature to develop guidelines to assist you in your practice. These guidelines provide age- and gender-specific preventive care and condition-specific recommendations. Take advantage of these resources today!

More Enhancements Coming to the iExchange^® Benefit Preauthorization Tool
We’ve made enhancements and continue to improve iExchange, our Web-based benefit preauthorization tool. iExchange supports requests for behavioral health, pharmacy and medical/surgical treatment services. Learn more about iExchange.

Nov. 11 Remittance Viewer Webinar Reminder
Our remittance viewer is a convenient online tool that gives providers a faster, easier way to view their claim payment information from BCBSTX. Join us for a November webinar to learn more about the tool.

BCBS Executive Now a Contributor to The Huffington Post
Check out Blue Cross and Blue Shield Executive Dr. Stephen Ondra’s article in The Huffington Post about the need for greater price transparency in health care and what our company is doing about it.

BCBSTX's Behavioral Health Program Proven to Help Reduce Claim Costs
An estimated 10 million people in the U.S. have a serious mental illness – many of whom need inpatient care. BCBSTX’s Behavioral Health Care Coordination and Early Intervention program helps identify and engage at-risk patients who may need additional help after in-patient treatment. Read more about how this program helped achieve 46 percent lower behavioral health claims costs.

Behavioral Health Utilization Management Affirmation Statement
Please help ensure your patients receive medically necessary and appropriate behavioral health care. Visit our provider website to learn more about the medical necessity criteria for behavioral health.

Notices and Announcements
In this issue of the newsletter, we offer November and December webinars for two Health Insurance Marketplace products, and we provide guidelines that hospital personnel may use to identify services that are not separately billable. Also, our behavioral health representatives are available to help with questions about member benefits, requests for authorization and more. 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,you should submit all changes at least 30 days in advance of the effective date of change. Please submit your correspondence via:

• fax: 972-231-9664
• mail: P.O. Box 650267, Dallas, Texas, 75265-0267

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.