October 2015

(Electronic distribution October 8, 2015)

View a printable PDF of this newsletter.

BCBSTX Announces Changes for Individual Plans in 2016
For the open enrollment period beginning Nov. 1, 2015, we will make changes to our Blue Advantage HMO product offerings statewide. Providers interested in participating in our networks can request participation through BCBSTX's provider portal. Get the details.

Join Us for October ICD-10 Direct Data Entry Claim Submission Webinars
We strongly encourage electronic submission of all professional and institutional claims for greater efficiency, accuracy and security of data. Join us for October webinars to learn what you need to do.

Provider Claim Summary Update: ‘Ntwk Diff’ Column
You may have noticed a recent, new column titled "Ntwk Diff” that has been appearing on some of your patients’ Provider Claim Summaries (PCS). This is an unintended occurrence from an August 2015 coding change that has no financial impact to either your practice or the member's claim record. By mid-October, we expect to have a solution to prevent this erroneous column from displaying on the PCS.

Join Dr. Esteban Lopez in Latino Health Care: Turning Barriers into Bridges
By 2050, Hispanics in Texas are expected to represent more than half of all Texans. Meanwhile, this growing population currently remains largely uninsured and at risk of health complications. Join Dr. Esteban Lopez, M.D., the BCBSTX president of our South and Southwest region, in his outreach and video in The Texas Tribune to discuss Latino Health Care: Turning Barriers into Bridges.

Pharmacy Program Updates Effective Oct. 1, 2015
Revisions were made to the BCBSTX standard drug list effective Oct. 1. These changes were made based on the availability of new prescription medications and the Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market.

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 last of a three-part series, we provide real-life examples of those who received help through palliative care.

Antipsychotic Drug Use in Elderly Patients with Dementia
A new national goal has been set to achieve a 25 percent reduction in antipsychotic drug use within nursing homes by the end of 2015, with a 30 percent reduction by the end of 2016. Eleven states met the previous 2012 goal to reduce antipsychotic drug use within nursing homes by 15 percent. See the announcement.

Notices and Announcements
In this issue of the newsletter, we announce key points to remember considering the adaption of ICD-10 and a reminder about caring for patients with asthma. 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.