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What's New
Attention Professional Electronic Submitters
Evidence Based Reimbursement
Clotting Factor Product Initiative
Coordination of Benefits and Patient Share
Maternity Program: A Healthy Start for Mothers and Babies
Downtime Alert - RediLink Production System
Guaranteed Coverage to all Affected UniCare Members
Untimed Billing Procedure CPT Codes
Walmart Behavioral Health Benefit Announcement
Provider Claim Summaries on all Adjustments - Coming Soon!
Special Coverage for H1N1 Vaccine
EDI Update
PCS to EPS: 30-Day Transition Reminder
eCards for Health
Important - New Process for Use of Out-of-Network Providers - Effective December 1, 2009
Clear Claim Connection 4.0
New Availity Claims Research Tool can improve your claims accuracy, office efficiency
Proper Speech Therapy Billing
FDA New Warnings/Proposed Changes to Acetaminophen Products
Medicare Corrected Claims
Corneal Transplant Predeterminatiion Process
Are You Billing for Compound Drugs?
Availity Participating Provider Training Webinars - November 2009

Disclosure Notices
Evidence Based Reimbursement
Change to the HMO Blue Texas Outpatient Clinical Reference Lab Services effective November 1, 2009
Code Auditing Upgrade & Modifier 59 Exempt Auditing - eff Oct 19, 2009
Quarterly Drug and Home Infusion Drug Fee Schedule Updates effective 12/1/09 have been posted under Reimbursement Schedules as of 9/1/09
Fee Schedule Update

Provider Education

Blue Review
Distribution date of November 6, 2009

Blue Review
Issue 3 - 2009

Blue Review Archives
   
Electronic Commerce
  		• Alerts
  		• Availity L.L.C.
  		• eCare/NDAS Online
  		• EDI Format Specifications
  		• EDI Transactions
  		• EFT/ERA Forms
  		• Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA)
  		• Electronic Provider Tools Reference Guide
  		• Electronic Refund Management (ERM) is here!
    • eRM Webinars
    - Sept 2009
  		• Explore Paperless Possibilities
  		• HIPAA
  		• iEXCHANGEŽ Web -
    Automated Precertification
    and Referral System
     

        • Getting Set-Up with
           iEXCHANGE Web

     

        • Web Reference Guide
            • Web Tip Sheet
  		• Online Transaction Tip Sheets
  		• RealMed

    Provider Library
  		• BlueCard®
  		• BlueCompare for Physicians
  		• BlueCompare for Hospitals
  		• Bridges to Excellence
  		• Claim Appeal/ Reconsideration Review Process & Billing Dispute External Review Process (BDERP)
  		• Claim Pointers
  		• Evidence Based Measures
  		• Facility Out-of-Network Care Enrollee Notification Form - New Process Effective December 1, 2009
  		• FAQs
  		• Learn More About
    • BlueChoice Solutions
    • Blue Medicare PPO

        • Mandatory Provider
           Fraud, Waste & Abuse
           Training

    • Blue Medicare Private
       Fee-for-Service
         • Terms and Conditions
    • HealthSelect
    • TriWest
  		• National Provider Identifier
  		• Physician Advisory Committee (PAC)
  		• Provider Education
    • New Provider Orientation
    • Existing Provider
      Orientation
    • Refresher Orientation
    • Time to be Blue
  		• Provider Manuals Requires password for access
  		• Reference Guides
  		• Special Investigations Tutorial
  		• Wellness Initiatives/Programs
    General Reimbursement Information

  • Bundling Information Requires password for access
    • Clear Claim Connection
     
  		• Recoupment/Refund Requires password for access
     
  		• Schedules Requires password for access
     
  		• Significant Edits Requires password for access
     
  		• ...and more... Requires password for access

    Medical Policy

  • Draft Medical Policies

  • Active/Pending Medical Policies

     
  		• Medical Policy Medical Records Documentation Guidelines (Predeterminations/Claims)

    Credentialing/
    Contracting
  		• Ten Great Reasons to be Blue
  		• Provider Record/ Credentialing
  		• Consent to Assignment of Provider Contracts (Change of Ownership-CHOW)

    UM/QI/Medical Management

  • Behavioral Health Medical Necessity Criteria
  		• Clinical Practice and Behavioral Health Guidelines
  		• Clotting Factor Product Initiative
  		• iEXCHANGE® - Automated Precertification and Referral System
  		• Postpartum Depression - The “Andrea Yates Bill”
  		• Radiology Quality Initiative/Preauth Prgm
  		• Step Therapy Guidelines for City of Houston (COH)
     
  		• Wellness Guidelines
    		 
    Pharmacy
  		• Digitek Recall
  		• Medicare Part D Updates
  		• Medicine Safety Project
  		• Override Request (pdf - 18k)
  		• Preferred Drug Guide
  		• Proton Pumps (pdf - 28k)
  		• Quantity vs. Time
  		• Specialty Programs
    • Triessent
    • Factor Drugs (Accredo)
    • Lupron (TAP Pharmacy   Solutions)
  		• Step Therapy/Prior Authorization
  		• Synagis & RSV
  		• Topical Verapamil

    Provider
    Tools/Programs
  		• Be Smart. Be Well.TM
    • Address Childhood
      Obesity Epidemic
    • Caregiving
    • Mental Health
      Announcement
  		• Blue Distinction
  		• Care Comparison® Tool
  		• Obesity Management Tool Kit Web Site


     
     
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