February 2018

Medicaid

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:

• HEDIS^®
• LARC (long-acting reversible contraception)/LARC devices
• Small alternative devices
• Taking action against asthma
• Webinars and more

2018 Preauthorization List Updates

Applies to: Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM

This notice has been updated to include a change to the BCBSTX Medicare Advantage Current Procedural Terminology^® Preauthorization Code List.

HMO Plans – PCP Selection and Referral Requirements

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

Reminders

• Annual Medical Record Data Collection for Quality Reporting Began Feb. 1, 2018
• Behavioral Health Program Changes for Boeing Members, Effective Jan. 1, 2018
• Skilled Nursing Facility Benefit Change for Federal Employee Plan Members
• Preventive Care Guidelines Are Available
• Requesting Predetermination of Benefits
• Preauthorization and Referral Requirements Lists Changed Jan. 1, 2018
• Blue Cross Medicare Advantage^SM Preauthorization List Update
• Know the Requirements for Preauthorization/Prior Authorization Rules and Retrospective Reviews for Medical Necessity

Electronic Commerce Services Hours Update; Educational Webinars Available

The Electronic Commerce Services Center hours are changing March 5. The Center is available to answer questions or if you experience issues with Electronic Data Interchange (EDI) transactions or online tools. Learn more about EDI transactions and other available electronic options by attending our webinars.

Reminders

• Zero Copay for Preventive Services Reminder
• Processing Claims for Preventive Colonoscopies
• MAO Coverage of Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease
• Find BCBSTX Resources in Availity^TM Payer Spaces
• Government Programs: 835 Electronic Remittance Advice Update
• National Drug Code Billing Update for Blue Cross Medicare Advantage Claims

Colon Cancer Screenings Goal: 80% Member Participation in 2018 – Will You Commit?

BCBSTX has pledged to have 80 percent of our members between the ages of 50 and 75 screened for colon cancer by the end of 2018. To accomplish this, we need your help! Review actions you can take to make a difference.

Reminders

• 2017 Annual HEDIS and QRS Reports
• Provider Manual Update

Sensipar^® (cinacalcet) No Longer Separately Reimbursable Under Medicare Part D for ESRD

Effective Jan. 1, the Centers for Medicare & Medicaid Services (CMS) determined the drug Sensipar will no longer be separately reimbursable under the Medicare Part D benefit when administered for hemodialysis. Learn what members with ESRD may be able to do to continue Sensipar therapy.

Reminder

• Pharmacy Benefit Tips

Provider Payments for Influenza Vaccines for 2017-2018 Flu Season

Applies to: Blue Cross Medicare Advantage PPO and Blue Cross Medicare Advantage HMO

Be sure to review new CMS notifications regarding influenza virus vaccines.

Reminder

• CMS Guidance Notifications

Reminders

• Provider Webinars Scheduled for 2018
• Update to the Durable Medical Equipment/Prosthetics and Orthotics Fee Schedule, Effective Dec. 1, 2017
• New Medical Record Retrieval Vendor for BlueCard^® Plan Member Records
• BlueOptions^SM Benefit Plan Design No Longer Offered

Reminder

• BCBSTX Requires Adherence to Vaccine Guidelines

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an Independent Licensee of the Blue Cross and Blue Shield Association

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