Pharmacy Program Updates


Blue Review

A newsletter for physician, professional, facility, ancillary and Medicaid providers

March 2018


Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids & CHIP Providers

Read this month’s Medicaid newsletter to learn about:

  • FMSA mandatory training
  • How to update your provider information
  • Private Duty Nursing requirements
  • Zika prevention
  • Health tips to share with your patients
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Network Participation

Keep Your Information Updated to Receive Quick and Accurate Payments

To provide the best service to you and your patients, it's very important that all the information BCBSTX has about your practice is current and accurate. Be sure to let us know about any changes to your practice address, email and/or physician rosters. Keeping us informed of any changes to your information helps us pay your claims more quickly and accurately. It also makes it easier for your patients to get current and correct information on Provider Finder®. Please update your information by completing the Demographic Change form.

Clinical Resources

Infusion Therapy Prior Authorization Requirements for ERS HealthSelectSM of Texas and Consumer Directed HealthSelectSM Participants

Review prior authorization requirements for home infusion therapy and infusion therapy performed in an office setting.

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New Preauthorization Requirements for Blue Choice PPOSM H-E-B Members

Access the updated Blue Choice PPO self-insured preauthorization list, which includes a requirement for non-emergent air ambulance services for H-E-B members effective June 1, 2018.

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Correction to HMO Plans – PCP Selection and Referral Requirements

Get a reminder about which plans are included in BCBSTX’s HMO plans. Also review a table that defines when Primary Care Provider (PCP) referrals to specialists are required and when they are not.

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Colorectal Cancer Screening Options and Statistics – Get the Conversation Started Today

To help you commit to our 2018 colon cancer screening goal, we’re providing a list of screening options and some startling statistics about colon cancer. We hope these statistics will get the conversation started with your patients.

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Claims & Eligibility

AvailityTM Claim Research Tool Offers Enhanced Claim Status Results

The Availity Claim Research Tool (CRT) provides easy, convenient and secure access to request claims status. This article includes a tip sheet, further information about the benefits of the CRT and access to complimentary Back to Basics: Availity 101 webinars.

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Standards & Requirements

Medicare Marketing Guidelines

Review the Centers for Medicare & Medicaid Services’ (CMS) annually updated Medicare Marketing Guidelines. The guidelines reflect CMS’ interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules. The guidelines are for use by Medicare Advantage plans, Medicare Advantage Prescription Drug plans, Prescription Drug plans and 1876 cost plans. The guidelines allow organizations offering both Medicare Advantage and prescription drug plans the ability to reference one document when developing marketing materials.

Quality Improvement Program (QIP) Information Available to Providers

BCBSTX’s QIP focuses on preventive and behavioral health, patient safety and condition management. Member care and services are evaluated regularly to determine whether members are receiving appropriate care and service, and that they are satisfied with their health plan. Information about BCBSTX’s QIP is available on our website.

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Education & Reference

Making the Health Care System WorkSM – The Intersection of Physical and Behavioral Health Care

Making The Health Care System WorkAll of us – individuals, providers, employers and insurers – have a vital role to play in the health care system. Making the Health Care System Work is an online magazine that explores how we can make the health care system work better for everyone. Article categories include: access to care, cost drivers, health and innovation. This month, check out The Intersection of Physical and Behavioral Health Care. Read the articles for yourself, recommend them to your colleagues, staff, patients, friends and family.

Video Series: Blue PromiseSM – Accessing Telemedicine

Making The Health Care System WorkBlue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts. If you’re interested in telemedicine or telehealth for your patients, take a few minutes to learn about this growing trend. In this edition of Blue Promise, Dr. Dan McCoy, BCBSTX President, goes over the basics of how telemedicine can help improve patients’ access to health care. Feel free to share these videos with your colleagues, staff, patients, friends and family.

Pharmacy Program


CMS Guidance Notifications


Notices & Announcements


Health & Wellness Tips to Share

BCBSTX’s LifeTimes website has many articles on a range of topics including: bone and joint health, cancer, diabetes, general health, and heart and lung health. Spanish is available.

The Connect Community provides articles, blogs and videos, and visitors can ask questions and get answers. Topics include everything from improving well-being to explaining health coverage. Spanish is available.


Did You Know?

Did You Know (formerly In Every Issue) provides an ongoing collection of articles to assist provider offices with servicing BCBSTX members. Access this month’s articles.

BCBSTX is required to provide certain notices in all published correspondence with physicians, professional providers, and facility and ancillary providers. For the latest updates, visit the News and Updates section of the BCBSTX provider website.

Printable PDF

View a printable PDF of the non-Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

Update Your Information

Do you need to update your location, phone number, email or other important details on file with BCBSTX? Use our online forms to request information changes.

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