2024 News and Updates

12/30/24 Review of Rescinded Prior Authorization Exemptions
12/24/24 Removal of Dermatology Referral Requirement for HealthSelect of Texas Effective 01/01/2025
12/18/24 Records Needed to Support Quality Care for Medicare Advantage Members
12/18/24 CPCP006 Preventive Services Policy Updated Effective 01/01/2025
12/18/24 Medical Records Collection for Federal Employee Program^® Begins in February
12/18/24 Ensure Your Office Is Providing Your Most Current Information
12/17/24 Annual Review: CPCP027 Inpatient Readmissions Updated
12/16/24 Remind Billing Agencies to Correctly Submit Claim Review Requests
12/13/24 Follow-Up Care Is Recommended for Children Prescribed ADHD Medication
12/11/24 2025 Holiday Schedule Reminders for E-Commerce
12/10/24 Remind Our Members about Cervical and Breast Cancer Screenings
12/09/24 Solutions and Results Monitoring for Gene Therapy Treatments to Launch in 2025
12/09/24 Update Your Records for New Blue Cross Group Medicare Advantage Open Access (PPO)^SM Members
12/09/24 CMS Tracks High-Risk Medication Combinations with New Part D Quality Measures
12/06/24 Keep Your Contact Information Updated to Receive Recredentialing Reminders
12/03/24 Updated Lab Management Clinical Payment and Coding Policies for Certain ASO Groups
12/03/24 Comparing Commercial and Retail BCBSTX Member Satisfaction with Providers
11/27/24 Funds to Be Recouped on Some Medicare Advantage Hospital and Ancillary Claims
11/26/24 Coding Reference for Quality Measures Is Available to Help Identify Gaps in Care
11/25/24 Preferred Drugs to be Recommended Through Enhanced Prior Authorization
11/25/24 ClaimsXten™ Quarterly Update Effective March 17, 2025
11/13/24 Reminder: Medical Transportation Utilization Management Via Alacura Effective Jan. 1, 2025
11/13/24 Annual Review: CPCP029 Medical Record Documentation Updated
11/12/24 Follow CMS Guidelines for Appointment Wait Time Standards
11/12/24 CPCP036 Paravertebral Facet Injection Procedure Billing & Coding Policy Updated Effective 02/13/2025
11/12/24 CPCP008 Psychological and Neuropsychological Testing Updated Effective 02/13/2025
11/12/24 CPCP020 Drug Testing Clinical Payment and Coding Policy Updated Effective 02/13/2025
11/07/24 SmartRx Assist^® Changes Its Name to HelpScript
11/04/24 How to Submit Photos to Accompany Prior Authorization or Recommended Clinical Review Requests
11/01/24 Medical Transportation Utilization Management for Some Members Updated Effective Jan. 1, 2025 (Updated)
11/01/24 Pharmacy Program Quarterly Update Changes Effective Jan. 1 2025 – Part 1
10/31/24 Prior Authorization Code Updates for Medicare Advantage Members Effective January 1, 2025
10/29/24 CPCP011 Applied Behavior Analysis – Effective 02/01/2025
10/28/24 Check ID Cards for New Coupe Health Plan Members (Updated)
10/25/24 Code Effectively to Earn Additional Incentive Payments on Medicare Advantage Claims
10/24/24 Talk to Our Members About the Flu Vaccine
10/23/24 Encourage Annual Eye Exams for Our Members with Diabetes
10/23/24 Statin Therapy Is Recommended for Patients with Cardiovascular Disease and Diabetes
10/17/24 Update: Medical Policy Updates for Self-Administered Drugs Effective April 15, 2025
10/15/24 Medicare Prescription Payment Plan Launching Jan. 1, 2025
10/15/24 MyBlue Health^SM Network Expansion Effective Jan. 1, 2025
10/11/24 Important Benefit Changes For Fully Insured Texas Group Plans (Revised from 10/1/2024)
10/09/24 Risk Identification and Outreach Program Supports Member Safety
10/04/24 30-Day Supply Limit: Select Commercial Members Have New Pharmacy Benefit for GLP-1 and/or Anti-Obesity Drug Therapy
10/04/24 Annual Review: CPCP042 Emergency Department Services Evaluation and Management - E/M Coding - Professional Services
10/03/24 Annual Review: CPCP032 Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy
10/03/24 Prior Authorization Code Changes for Commercial Members Effective Jan. 1, 2025
10/03/24 Additional Claim Processing Enhancements for ERS Plans Effective October 21, 2024 - Updated
10/02/24 Acquisition of Cigna Healthcare Medicare Business in 2025
10/01/24 Check ID Cards for New Coupe Health Plan Members
10/01/24 Important Benefit Changes For Fully Insured Texas Group Plans
9/30/24 Site of Care Utilization Management Review for Advanced Imaging Effective Jan. 1, 2025
9/30/24 Medical Transportation Utilization Management for Some Members Updated Effective Jan. 1, 2025
9/30/24 Updates Coming to Behavioral Health Substance Use Disorder Criteria for Utilization Management
9/30/24 New Laboratory Claims Review for Certain ASO Groups - Jan. 1, 2025
9/2524 CPCP006 Preventive Services Policy Update Effective 10/01/2024
9/24/24 Pharmacy Program Quarterly Update Changes Effective Oct. 1, 2024 – Part 2
9/18/24 Coordinating Care after Hospital Discharges Can Help Our Members’ Transition
9/10/24 Register for a Coding Webinar on Coagulation Defects and Other Hematological Disorders
9/09/24 In-home Test Kits Help Our Members Manage Their Kidney Health
9/06/24 ClaimsXten™ Quarterly Update Effective Dec. 9, 2024
9/05/24 Updated Claims Referral Form for American Indian/Alaska Native Limited Cost Share Plans
9/01/24 Prior Authorization Exemption Notifications for Jan. 1 - June 30, 2024 Review Period
8/28/24 Annual Review: CPCP035 Unlisted/Not Otherwise Classified (NOC) Coding Policy effective 08/29/2024
8/28/24 Reminder: Recommended Clinical Review for Outpatient Services Effective Sept. 1 for TRS Participants
8/24/24 Texas Senate Bill 1040 Prohibits Organ Transplants Associated with China
8/23/24 Claim Processing Enhancements for ERS Effective Sept. 1, 2024 (Updated)
8/21/24 Reminder: Update to Recommended Clinical Review Effective Sept. 1, 2024 for ERS Plans
8/21/24 Out-Of-Network Urgent & Emergent Providers Blue High Performance Network^® Reimbursement Update
8/20/24 CPCP026 -Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding Updated Effective 11/21/2024
8/20/24 Pharmacy Program Quarterly Update Changes Effective Oct. 1, 2024 – Part 1
8/19/24 Cancer Prevention Vaccine? The sooner the better!
8/15/24 Revised Coding for Consultation Services – See our Clinical Payment and Coding Policy CPCP024 Evaluation and Management Coding – Professional Services
8/14/24 Encourage Medicare Members to Respond to Health Outcomes Survey
8/13/24 Annual Review: CPCP001 Observation Services Policy effective 08/14/2024
8/12/24 Shared Decision-Making Aids Can Help Guide Care Choices
8/08/24 Check ID Cards for New Coupe Health Plan Members
8/05/24 Language Line Supporting Cultural Competence
8/02/24 Additional Claim Processing Enhancements for ERS Plans Effective October 21, 2024
7/31/24 Annual Review: CPCP031 - Trauma Activation- Facility Services Updated Effective 08/01/2024
7/31/24 Abiraterone Drug Coverage Changes Coming for Many Commercial Members
7/30/24 Annual Review: CPCP004 Neonatal Intensive Care Unit/NICU Level of Care Authorization and Reimbursement Policy Updated Effective 07/31/2024
7/26/24 Prior Authorization Code Updates for Medicare Advantage Members, Effective Oct. 1, 2024
7/25/24 Annual Review: CPCP003 Emergency Department Services Evaluation and Management: E/M Coding – Facility Services Effective 07/26/2024
7/23/24 Physician Performance Insights Reports Are Now Available
7/19/24 Speaking Out About the ‘Silent Killer’
7/17/24 Provider Depression Disorder Prescribing
7/17/24 Has Your Information Changed? Update Us and the NPI Registry
7/16/24 Check Prior Authorization Requirements for Procedure Codes through Availity^® Essentials or Our IVR System
7/16/24 Provider Finder^® Ranks Providers to Help PPO Members Find Care
7/15/24 Annual Review: CPCP041 Sepsis Policy Updated Effective 07/16/2024
7/12/24 Medicare Providers May Treat Blue Cross Group Medicare Advantage Open Access (PPO)^SM Members
7/12/24 Annual Review: CPCP039 Outpatient Facility Service(s) Overlapping During an Inpatient Stay Updated Effective 07/15/2024
7/10/24 Annual Review: CPCP021 Laboratory Panel Billing Updated Effective 07/11/2024
7/09/24 CPCP012 Hernia Repair Updated Effective 10/10/2024
7/09/24 Earn Continuing Education Credit: Webinar on Avoiding Inappropriate Antibiotic Use
7/03/24 Breast Cancer Screening for Members Ages 40 to 74
7/01/24 2024 Prior Authorization Exemption Renewal Results
7/01/24 Review of Rescinded Prior Authorization Exemptions
6/27/24 Prior Authorization Code Changes for Commercial Members Effective Oct. 1
6/27/24 Pharmacy Program Quarterly Update: Changes Effective July 1, 2024 – Part 2
6/27/24 Update to CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services - Effective 10/01/2024
6/27/24 CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services Updated – Effective 07/01/2024
6/26/24 CPT Category II Codes Can Help Close Care Gaps
6/24/24 Annual Review: CPCP034 Unbundling Policy-Professional Providers Updated Effective June 25, 2024
6/24/24 Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units
6/21/24 NICU Utilization Management Update Effective Sept. 1, 2024, for ERS Plans
6/20/24 CPCP006 Preventive Services Policy Update Effective 07/01/2024
6/20/24 Coming Soon – New Learning & Training Center in Availity^® Essentials
6/18/24 Provider Rights and Responsibilities
6/18/24 Member Rights and Responsibilities
6/20/24 New Coupe Health Plan: Update Your Member Records
6/10/24 Encourage Routine Vaccines and Well-Care Visits for Children and Teens
6/07/24 GLP-1 New to Therapy Optional Benefit Program Available for Select Commercial Members
6/07/24 In-Home Test Kits for Colorectal Cancer Screening
6/05/24 TXCPCP03 Surgical and Non-Surgical Services Updated Effective 09/06/2024
5/31/24 Changing Prior Authorization to Recommended Clinical Review Effective Sept. 1 for TRS Participants
5/31/24 Utilization Management Update Including Change to Recommended Clinical Review Effective Sept. 1, 2024, for ERS Plans
5/31/24 Prime Therapeutics Drug Claims Processed in Error Without Required Prior Authorization
5/30/24 Update: Our Revised Clinical Payment and Coding Policy for Anesthesia Services Now Effective Aug. 14, 2024
5/29/24 Updated PEAQ^SM Methodology Is Now Available
5/28/24 Claim Processing Enhancements for ERS Effective Sept. 1, 2024
5/20/24 Access MCG Care Guidelines Clinical Criteria via Availity^®
5/20/24 Physician Performance Insights Coming Soon from PEAQ^SM
5/15/24 The Need for Better, Improved Continuity and Coordination of Care
5/15/24 ClaimsXten™ Quarterly Update Effective Aug. 19, 2024
5/13/24 Closing Gaps in Care for Group Medicare Advantage (PPO) members
5/09/24 Behavioral Health Consultations During Medical Hospitalization Can Improve Outcomes
5/09/24 Helping Our Members Manage Diabetes
5/07/24 Pharmacy Program Quarterly Update: Changes Effective July 1, 2024 – Part 1
4/30/24 PeriPAN Perinatal Mental Health Toolkit for Obstetric Clinicians
4/29/24 Annual Review: CPCP032 - Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy
4/29/24 Electronic Claim Review and Ensuring the Correct Use of our Claim Review Form
4/24/24 Annual Review: CPCP036 Paravertebral Facet Injection Procedure Coding & Billing Policy Updated
4/23/24 Annual Review: CPCP005 Home Health Care/Private Duty Nursing Policy Updated
4/23/24 CPCP029 Medical Record Documentation Updated Effective 07/24/2024
4/19/24 Annual Review: CPCP018 OP Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT^®, HCPCS and/or NDC Codes Updated
4/19/24 Annual Review: CPCP019 Home Infusion Updated
4/18/24 Important Updates to Manage My Organization in Availity^® Essentials
4/17/24 Prior Authorization Code Updates for Medicare Advantage Members, Effective July 1, 2024
4/10/24 BCBSTX 2023 Marketplace Member Satisfaction with Providers Results
4/08/24 Supporting Maternal Quality Care
4/04/24 Filing Claims for Behavioral Health Services – Use the Correct Place of Service Code
3/29/24 Prior Authorization Code Changes for Commercial Members Effective July 1, 2024
3/29/24 Pharmacy Program Quarterly Update: Changes Effective Apr. 1, 2024 – Part 2
3/29/24 CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Updated Versions – Effective 4/01/2024 & 05/15/2024
3/28/24 ImmTrac2: Shot Records in One Secure Place
3/28/24 CPCP025 Corrected Claim Submission Updated Including Changes for Late/Added Charges
3/26/24 CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Updates- Effective 7/01/2024
3/26/24 CPCP006 Preventive Services Policy Update Effective 04/01/2024
3/13/24 Webinar on Coding for Medicare Advantage Annual Wellness Visits
3/13/24 Caring for Substance Use Disorders
3/12/24 Continuity and Coordination of Eye Care
3/12/24 Recommended Clinical Review Services and Code List Changes for Certain Members
3/11/24 Earn Continuing Education Credit: Webinar on Substance Use Disorder
3/07/24 ClaimsXten™ Quarterly Update Effective June 17, 2024
3/05/24 Annual Review: CPCP002 Inpatient/Outpatient Unbundling Policy- Facility Updated Effective 03/06/2024
3/04/24 Change Healthcare Cybersecurity Incident Impact and Options
3/04/24 Annual Review: CPCP017 Wasted/Discarded Drugs and Biologicals Policy Updated Effective 03/05/2024
2/29/24 Notifications for Prior Authorization Exemptions for July 1 to Dec. 31, 2023 Review Period
2/29/24 CPCP033 Telemedicine and Telehealth/Virtual Health Care Services Policy Updated Effective 05/01/2024
2/28/24 See New Effective Date for Claim Editing Changes for Facility Emergency Department Services
2/28/24 Reminder: Prior Authorization Changing to Recommended Clinical Review for Certain Services for TRS Participants
2/26/24 Earn Continuing Education Credit: Webinar on Social Determinants of Mental Health Care
2/23/24 Annual Review: CPCP022 Pneumatic Compression Devices – Outpatient Use Updated
2/21/24 Annual Review: CPCP038 Outpatient Services Prior to an Inpatient Admission Updated
2/20/24 Pharmacy Program Quarterly Update: Changes Effective Apr. 1, 2024 – Part 1
2/20/24 30-Day Facility Readmission Reviews for Medicare Advantage Members
2/14/24 CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Update- Effective 5/15/2024
2/14/24 Recommended Clinical Review Procedure Code List Changes for Commercial Members Effective May 15, 2024
2/09/24 Closing Gaps in Colon Care
2/09/24 Avoiding Inappropriate Use of Antipsychotic Medication in Anxiety Disorders
2/08/24 Follow-up Care for Mental Health
2/01/24 Fighting Fraud, Waste and Abuse
1/30/24 Changes to Claim Inquiry Resolution – High-Dollar, Pre-Pay Reviews Only
1/29/24 Medicare Advantage HEDIS Records Collection through June 2024
1/29/24 Reminder: BCBSTX Prior Authorization Exemption Communication Method Preference
1/26/24 HealthSelect of Texas^® In-Area Participants PCP Referral Requirement for In-Network Benefits
1/26/24 Introducing Smart RxAssist via HealthSmartRx^®
1/25/24 Annual Review: CPCP016 Chiropractic Care Services Updated
1/24/24 Annual Review: CPCP015 Multiple Surgical Procedures-Professional Provider Services Updated
1/22/24 Continuing Education Credit Webinar on Pediatric Behavioral Health
1/22/24 NDC Billing Tool on Our Provider Website is Being Retired
1/19/23 Annual Review: CPCP014 Global Surgical Package – Professional Providers Updated
1/19/23 Annual Review: CPCP040 Physical Medicine and Rehabilitation Services Updated
1/18/24 CPCP023 Modifier Reference Policy Update– Effective 04/19/2023
1/18/24 Annual Review: CPCP013 Increased Procedural Services (Modifier 22) Updated
1/18/24 Annual Review: CPCP009 Co-Surgeon/Team Surgeon Modifiers Updated
1/17/24 Pharmacy Program Quarterly Update, Part 2, Changes Effective January 1, 2024
1/17/24 Coding Webinars: Major Depressive Disorder and Annual Wellness Visits
1/16/24 Annual HEDIS/QRS Reports
1/12/24 Supporting Healthy Hearts
1/12/24 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and QHP Enrollee Experience Survey (EES)
1/11/24 Prior Authorization Code Updates for Medicare Advantage Members Effective April 1, 2024
1/09/24 ClaimsXten™ Quarterly Update Effective April 15, 2024
1/08/24 Update to Prior Authorization Code Changes for Commercial Members Effective April 1, 2024
1/08/24 Managing Antidepressant Medication
1/03/24 Federal Employee Program (FEP^®) HEDIS^® Medical Records Collection February - April 2024