HMO Plans – PCP Selection and Referral Requirements


Blue Review

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

February 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:

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

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.

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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.

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Claims & Eligibility

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.

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Education & Reference

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.

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Pharmacy Program

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.

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CMS Guidance Notifications

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.

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Notices & Announcements


Standards & Requirements



In Every Issue

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 area of the BCBSTX provider website. Access this month’s articles.

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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an Independent Licensee of the Blue Cross and Blue Shield Association

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