2024 News and Updates

06/10/2024 Encourage Routine Vaccines and Well-Care Visits for Children and Teens 

06/07/2024 GLP-1 New to Therapy Optional Benefit Program Available for Select Commercial Members 

06/07/2024 In-Home Test Kits for Colorectal Cancer Screening

06/05/2024 TXCPCP03 Surgical and Non-Surgical Services Updated Effective 09/06/2024

05/31/2024 Changing Prior Authorization to Recommended Clinical Review Effective Sept. 1 for TRS Participants

05/31/2024 Utilization Management Update Including Change to Recommended Clinical Review Effective Sept. 1, 2024, for ERS Plans 

05/31/2024 Prime Therapeutics Drug Claims Processed in Error Without Required Prior Authorization

05/30/2024 Update: Our Revised Clinical Payment and Coding Policy for Anesthesia Services Now Effective Aug. 14, 2024

05/29/2024 Updated PEAQSM Methodology Is Now Available

05/28/2024 Claim Processing Enhancements for ERS Effective Sept. 1, 2024

05/20/2024 Access MCG Care Guidelines Clinical Criteria via Availity®

05/20/2024 Physician Performance Insights Coming Soon from PEAQSM

05/15/2024 The Need for Better, Improved Continuity and Coordination of Care 

05/15/2024 ClaimsXten™ Quarterly Update Effective Aug. 19, 2024  

05/13/2024 Closing Gaps in Care for Group Medicare Advantage (PPO) members

05/09/2024 Behavioral Health Consultations During Medical Hospitalization Can Improve Outcomes

05/09/2024 Helping Our Members Manage Diabetes

05/07/2024 Pharmacy Program Quarterly Update: Changes Effective July 1, 2024 – Part 1

04/30/2024 PeriPAN Perinatal Mental Health Toolkit for Obstetric Clinicians 

04/29/2024 Annual Review: CPCP032 - Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy

04/29/2024 Electronic Claim Review and Ensuring the Correct Use of our Claim Review Form

04/24/2024 Annual Review: CPCP036 Paravertebral Facet Injection Procedure Coding & Billing Policy Updated

04/23/2024 Annual Review: CPCP005 Home Health Care/Private Duty Nursing Policy Updated

04/23/2024 CPCP029 Medical Record Documentation Updated Effective 07/24/2024

04/19/2024 Annual Review: CPCP018 OP Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT®, HCPCS and/or NDC Codes Updated

04/19/2024 Annual Review: CPCP019 Home Infusion Updated

04/18/2024 Important Updates to Manage My Organization in Availity® Essentials

04/17/2024 Prior Authorization Code Updates for Medicare Advantage Members, Effective July 1, 2024

04/10/2024 BCBSTX 2023 Marketplace Member Satisfaction with Providers Results

04/08/2024 Supporting Maternal Quality Care

04/04/2024 Filing Claims for Behavioral Health Services – Use the Correct Place of Service Code

03/29/2024 Prior Authorization Code Changes for Commercial Members Effective July 1, 2024

03/29/2024 Pharmacy Program Quarterly Update: Changes Effective Apr. 1, 2024 – Part 2

03/29/2024 CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Updated Versions – Effective 04/01/2024 & 05/15/2024

03/28/2024  ImmTrac2: Shot Records in One Secure Place      

03/28/2024 CPCP025 Corrected Claim Submission Updated Including Changes for Late/Added Charges 

03/26/2024 CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Updates- Effective 07/01/2024

03/26/2024 CPCP006 Preventive Services Policy Update Effective 04/01/2024

03/13/2024 Webinar on Coding for Medicare Advantage Annual Wellness Visits 

03/13/2024 Caring for Substance Use Disorders 

03/12/2024 Continuity and Coordination of Eye Care

03/12/2024 Recommended Clinical Review Services and Code List Changes for Certain Members

03/11/2024 Earn Continuing Education Credit: Webinar on Substance Use Disorder 

03/07/2024 ClaimsXten™ Quarterly Update Effective June 17, 2024 

03/05/2024 Annual Review: CPCP002 Inpatient/Outpatient Unbundling Policy- Facility Updated Effective 03/06/2024 

03/04/2024 Change Healthcare Cybersecurity Incident Impact and Options

03/04/2024 Annual Review: CPCP017 Wasted/Discarded Drugs and Biologicals Policy Updated Effective 03/05/2024

02/29/2024 Notifications for Prior Authorization Exemptions for July 1 to Dec. 31, 2023 Review Period

02/29/2024 CPCP033 Telemedicine and Telehealth/Virtual Health Care Services Policy Updated Effective 05/01/2024

02/28/2024 See New Effective Date for Claim Editing Changes for Facility Emergency Department Services

02/28/2024 Reminder: Prior Authorization Changing to Recommended Clinical Review for Certain Services for TRS Participants

02/26/2024 Earn Continuing Education Credit: Webinar on Social Determinants of Mental Health Care

02/23/2024 Annual Review: CPCP022 Pneumatic Compression Devices – Outpatient Use Updated

02/21/2024 Annual Review: CPCP038 Outpatient Services Prior to an Inpatient Admission Updated

02/20/2024 Pharmacy Program Quarterly Update: Changes Effective Apr. 1, 2024 – Part 1

02/20/2024 30-Day Facility Readmission Reviews for Medicare Advantage Members

02/14/2024 CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Update- Effective 05/15/2024

02/14/2024 Recommended Clinical Review Procedure Code List Changes for Commercial Members Effective May 15, 2024

02/09/2024 Closing Gaps in Colon Care

02/09/2024 Avoiding Inappropriate Use of Antipsychotic Medication in Anxiety Disorders 

02/08/2024 Follow-up Care for Mental Health

02/01/2024 Fighting Fraud, Waste and Abuse 

01/30/2024 Changes to Claim Inquiry Resolution – High-Dollar, Pre-Pay Reviews Only

01/29/2024 Medicare Advantage HEDIS Records Collection through June 2024

01/29/2024 Reminder: BCBSTX Prior Authorization Exemption Communication Method Preference

01/26/2024 HealthSelect of Texas® In-Area Participants PCP Referral Requirement for In-Network Benefits

01/26/2024 Introducing Smart RxAssist via HealthSmartRx®

01/25/2024 Annual Review: CPCP016 Chiropractic Care Services Updated

01/24/2024 Annual Review: CPCP015 Multiple Surgical Procedures-Professional Provider Services Updated

01/22/2024 Continuing Education Credit Webinar on Pediatric Behavioral Health 

01/22/2024 NDC Billing Tool on Our Provider Website is Being Retired

01/19/2023 Annual Review: CPCP014 Global Surgical Package – Professional Providers Updated

01/19/2023 Annual Review: CPCP040 Physical Medicine and Rehabilitation Services Updated

01/18/2024 CPCP023 Modifier Reference Policy Update– Effective 04/19/2023

01/18/2024 Annual Review: CPCP013 Increased Procedural Services (Modifier 22) Updated

01/18/2024 Annual Review: CPCP009 Co-Surgeon/Team Surgeon Modifiers Updated

01/17/2024 Pharmacy Program Quarterly Update, Part 2, Changes Effective January 1, 2024

01/17/2024 Coding Webinars: Major Depressive Disorder and Annual Wellness Visits

01/16/2024 Annual HEDIS/QRS Reports

01/12/2024 Supporting Healthy Hearts

01/12/2024 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and QHP Enrollee Experience Survey (EES)

01/11/2024 Prior Authorization Code Updates for Medicare Advantage Members Effective April 1, 2024

01/09/2024 ClaimsXten™ Quarterly Update Effective April 15, 2024  

01/08/2024 Update to Prior Authorization Code Changes for Commercial Members Effective April 1, 2024

01/08/2024 Managing Antidepressant Medication

01/03/2024 Federal Employee Program (FEP®) HEDIS® Medical Records Collection February - April 2024