 |
| |
CLAIMS & ELIGIBILITY |
|
New Coupe Health Plan: Update Your Member Records
Starting in October, providers in the commercial Blue Choice PPOSM and Blue High Performance Network® may start providing service to members in our new Coupe Health benefit plan. Learn how this plan streamlines the payment process for your office and our members.
|
|
|
|
Prime Therapeutics® Drug Claims Processed in Error Without Required Prior Authorization
A system error resulted in some BCBSTX members (with Prime as their pharmacy benefit manager) receiving paid claims without following the necessary prior authorization steps. Learn what to do if your patients were affected.
|
|
|
|
Coming Soon: New Learning & Training Center in Availity® Essentials
Beginning in August, Availity educational resources currently on our provider website will move to a new Learning & Training Center within Availity Essentials. All instructional user guides and instructor-led trainings will be available in this new location. Learn how to access the new training center.
|
|
|
|
Clinical Payment and Coding Policy Updates
Our website’s Clinical Payment and Coding Policies describe payment rules and methodologies for CPT®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies and does not address all reimbursement-related issues. We may add and modify clinical payment and coding policies. The following policy was added or updated:
|
|
 |
Reminders
|
|
|
|
|
| |
EDUCATION & REFERENCE |
|
Provider Learning Opportunities
We offer free webinars to contracted providers who service our members. These trainings focus on electronic options, and other helpful tools and resources. Review upcoming training sessions. Also, if you are a new provider or have new staff, please refer to our Provider Orientation Information. |
|
|
Reminder: Update Your Demographic Information
If you’ve changed your location, phone number, email or other details, it’s essential that you let us know so our members can locate you in our Provider Finder® tool. We suggest you periodically review yourself on Provider Finder to verify the accuracy of your information. Refer to the Verify and Update Your Information page for instructions on submitting changes. |
|
|
|
|
| |
HEALTH & WELLNESS |
|
‘GLP-1 New to Therapy’ Optional Benefit Program Available for Select Commercial Members
We have a new program – GLP-1 New to Therapy – that aims to reduce drug waste and the cost of care associated with beginning GLP-1 drug therapy. It can also help members utilize the medication as intended. |
|
|
|
In-Home Test Kits for Colorectal Cancer Screening
We’re working with vendors to send Fecal Immunochemical Test kits to select MyBlue HealthSM and Blue Advantage HMOSM members – at no additional charge. Learn how you can encourage members to take the test. |
|
|
|
Encourage Routine Vaccines and Well-Care Visits for Children and Teens
The CDC recommends doctors and health care professionals encourage families to schedule vaccines and wellness visits for their children. Check out our Children’s Wellness Guidelines for a routine immunization schedule. |
|
|
|
|
|
|
|
|
| |
MEDICAID |
|
Access all 2023 and 2024 news and updates for BCBSTX Medicaid (STAR), STAR Kids and CHIP providers.
|
|
|
Reminders
|
|
|
|
|
|
| |
NETWORK PARTICIPATION |
|
Provider Rights and Responsibilities
As a participating provider in our networks, you have certain rights and responsibilities that may affect your practice. This article includes information about your credentialing rights, case management programs, utilization management decisions and more. |
|
|
|
Member Rights and Responsibilities
As a participating provider, it’s important that you are aware of our members’ rights and responsibilities. This article includes information about members’ rights and their responsibilities, Texas Medicaid and more. |
|
|
|
|
| |
STANDARDS & REQUIREMENTS |
|
Updated PEAQSM Methodology Is Now Available
We regularly evaluate PEAQ’s three components (efficiency, appropriateness and quality) and refine the methodology based on new clinical data and input from practicing physicians. As such, an updated methodology is now available; it’s titled: PEAQ 4.0. |
|
|
|
Reminder
|
|
|
|
|
| |
UTILIZATION MANAGEMENT |
|
NICU Utilization Management Update Effective Sept. 1, 2024, for ERS Plans
Effective Sept. 1, ProgenyHealth® will be delegated for all neonatal intensive care unit admissions and concurrent reviews for the Employees Retirement System of Texas plans. Providers will have the option to notify ProgenyHealth pre-service to ensure medical necessity, level of care and that other plan requirements are met prior to submitting claims. |
|
|
|
Reminders
|
|
|
|
|
 |
Regulatory & Requirements
This section includes additional items related to regulatory requirements and operational processes to assist provider offices with servicing our members. Access this month’s articles .
We are required to provide certain notices in all published correspondence with health care providers. For the latest updates, visit the News and Updates section on the BCBSTX provider website.
|
|
|
 |
Printable PDF
View a printable PDF of the non‑Medicaid information in this newsletter.
|
|
|
|
|
|
|
|
|
|
|
|
File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. You can download other tools and learn more about accessibility at adobe.com  .
By clicking this link, you will go to a website/app (“site”). The site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. Some sites may require you to agree to their terms of use and privacy policy.
|
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
|
1001 E. Lookout Drive, Richardson, TX 75082
© Copyright 2024 Health Care Service Corporation. All Rights Reserved.
Legal and Privacy | Unsubscribe
view in Web Browser
|
|
|
|
| | | |
