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What's New
Physician Assistant and Advanced Practice Nurse Copayments
Blue Cross Member ID Cards Include Behavioral Health Pre-Cert Contact Information
Resolved: Missing Information on 835 Transaction - January 2010
Walmart 2010 Changes & Instructions
Electronic Transactions - 2010 Holiday Schedule Reminder
Pharmacy Compounding
Eligibility and Benefits Fax Back
Extended release Niacin vs. Ezetimibe: Results of the ARBITER 6-HALTS Trial
New Wellness Initiatives for Federal Employees eff January 1, 2010
Newly Designed Public Web Site Launches
System Upgrade For Medicare Crossover Claims
Care Comparison Data Collection Form - Update
Two-digit State Abbreviation Required on E-claims
Evidence Based Reimbursement
Clotting Factor Product Initiative
Coordination of Benefits and Patient Share
Maternity Program: A Healthy Start for Mothers and Babies
Guaranteed Coverage to all Affected UniCare Members
Untimed Billing Procedure CPT Codes - Update
Walmart Behavioral Health Benefit Announcement
Provider Claim Summaries on all Adjustments - Coming Soon!
Availity Participating Provider Training Webinars - February 2010

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 3/1/10 have been posted under Reimbursement Schedules as of 12/1/09 - Correction has been made to J7325 and posted as of 12/11/09
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)
  		• Explore Paperless Possibilities
  		• HIPAA
  		• iEXCHANGE® 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
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  		• Claim Pointers
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  		• Provider Manuals Requires password for access
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    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
  		• Physician/Professional Provider Credentialing & Contracting
    • Ten Great Reasons
       to be Blue
    • Provider Record/
       Credentialing
  		• Facility/Ancillary Credentialing & Contracting
    • Areas of Interest –
       TRICARE Only
    • 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
  		• eCards for Health
  		• 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
  		• 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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