Blue Cross Blue Shield of Texas Health Select Policy Guidelines
COVID-19 special edition included | view in Web Browser
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| A newsletter for physician, professional, facility, ancillary and Medicaid providers |
May 2020
Medicaid
Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers
Read this month's Medicaid news to learn about:
Notices & Announcements
COVID-19 Blue Review Special Bulletin
Extra, extra! Did you see our special edition of Blue Review covering COVID-19 news and updates? Be sure to check it out.
Provider Information on COVID-19 Coverage
Get information all in one place. We appreciate the care you are providing our members during the COVID-19 pandemic. With the evolving changes, you can use the Provider Information on COVID-19 Coverage page to get the most current information.
Alert: iExchange® Deactivation Extended
In response to COVID-19, the iExchange deactivation planned for April 15, has been temporarily suspended to allow you additional time to convert to the Availity® Authorizations & Referrals tool during this pandemic.
Have You Heard About the New Texas Surprise Billing Law?
What's new: A Texas law protects health plan members who received medical care on or after Jan. 1, 2020, from surprise bills in many situations where a member doesn't have a choice in where to get care.
Reminder:
- Telemedicine and Telehealth Coverage Expansion in Response to COVID-19
Behavioral Health
Behavioral Health Program Changes for HealthSelect of Texas ® Effective Sept. 1
As a reminder, starting June 1, 2020, we will administer behavioral health (BH) benefits for Blue EssentialsSM, Blue Essentials AccessSM, Blue PremierSM and Blue Premier AccessSM provider networks. Magellan Healthcare® will no longer administer behavioral health benefits for these members. Also, BH services for HealthSelect of Texas and Consumer Directed HealthSelectSM participants will transition on Sept. 1, 2020.
Reminder:
- 2019 Behavioral Health Quality Improvement Program Evaluation Executive Summary
Pharmacy
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2020 — Part 1
Review drug list changes, updates and revisions that go into effect July 1.
Reminders:
Claims & Eligibility
Billing for Point-of-Use Convenience Kits
You should know: Only the drug component(s) of point-of-use convenience kits will be reimbursed to providers. Why? Often, the cost of these convenience kits is more than the cost of its components when purchased one item at a time.
Check Eligibility and Benefits: Don't Skip this Step!
The Clinical Payment and Coding policies published on our website describe payment rules and methodologies for CPT®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is offered as a resource for our payment policies; it is not intended to address all reimbursement-related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process. The following have been recently added or updated:
Reminders:
- Clarification: New BCBSTX 837 Commercial Claim Validation Edits Effective April 1, 2020
- Three New ClaimsXtenTM Rules to be Implemented June 2020
Education & Reference
Blue Cross Medicare Advantage ® Orientation Training Webinar
Register today for a webinar to learn about providing the highest quality of care to our Medicare Advantage members and providing timely plan updates.
Complimentary Webinar Trainings Available
Do you have new staff or need a refresher about electronic options? If yes, we have added complimentary educational webinar sessions on the BCBSTX provider website for provider billers, utilization areas and administrative departments. Topics include Availity 101, Availity Authorizations & Referrals and Remittance Viewer. Please visit the Provider Training page on our provider website throughout the year to view available training topics and sign up for sessions.
Network Participation
Reminders:
- Using the Online Tool to Search for Doctors and Hospitals
- CMS Star Ratings Matter: Survey to Assess Medicare Advantage Members' Experiences
Prior Authorization Information
Reminder:
- New Prior Authorization & Referral Submission Tool via Availity Provider Portal
Health & Wellness
Reminder:
- New Annual Wellness Visit Resources for Medicare Providers
 | 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 health care providers. For the latest updates, visit the News and Updates section of the BCBSTX provider website. |
 | Printable PDFView a printable PDF |
 | Contact UsView 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 or want to receive the Blue Review by email? Use our online form to request information changes. |
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