POET LLC

HealthSelect ERS

Effective Sept. 1, 2021, HMO plans will no longer be an enrollment option under the Texas Group Benefit Program. All current subscribers and dependents enrolled in one of the HMO plans will be automatically enrolled in HealthSelect of Texas administered by Blue Cross and Blue Shield of Texas, unless they elect otherwise during their summer enrollment period

Participants who are transitioning from an HMO plan will have a 90-day referral grace period and will receive in-network benefits if they see an in-network specialist without a referral during this timeframe. After Nov. 30, 2021, if there is not a referral on file with BCBSTX, the specialist visit will be covered at the out-of-network benefit level, even if the specialist is in-network.

Effective Sept. 1, 2021, certain procedure codes are being removed from the list of services that require prior authorization for HealthSelect of Texas^® & Consumer Directed HealthSelect^SM participants. You can review a list of the codes being removed here . BCBSTX is currently working on system updates to reflect this change.

Remember to use Availity ^® or your preferred vendor to check eligibility and benefits before rendering services. This will help you confirm coverage details and prior authorization requirements and determine if you are in-network for the member’s policy. Refer to Eligibility and Benefits for details.

Flu Season Is Here

UHC Network News Brief 10/1/2021

Catch All the UHC UPDATES

October 2021 Policy and Protocol Updated Overview

Medical policy update: October 2021
Pharmacy Updates
Prior Authorization and Notification Requirement Updates and 2021 Summary of Changes
Reimbursement Policy Updates: October 2021
Specialty Medical Injectable Drug Program Updates: October 2021

News for BCBS Employer Groups

Sept. 24, 2021 | BCBSTX News

Update to 2022 Telehealth Services

In support of our members and employer groups, in 2022 we will continue to cover the expanded telehealth services that we’ve covered this year. This is our standard coverage.

Federal Government Releases Proposed Rule Related to Surprise Billing, Transparency

The proposed rule provides new regulations to implement sections of Consolidated Appropriations Act of 2021. Topics covered include air ambulance reporting, agent and broker compensation disclosure and reporting, and enforcement of No Surprises Act requirements

Vaccine Documentation Can’t be Required for Medical Treatment

The Texas Health and Human Services Commission (HHSC) is notifying practitioners who see Medicaid patients that those patients can’t be required to provide documentation of their COVID-19 vaccination status as a condition of receiving services under Texas Medicaid.

The agency’s Sept. 17 announcement references Gov. Greg Abbott’s Aug. 25 executive order, which bars “[a]ny public or private entity that is receiving or will receive public funds through any means” from requiring COVID-19 vaccination documentation to receive services.

Physician Directory Update

Who needs Google Maps, when you can download the Physician Directory from the POET INK files?

To download your front desk copy, just click.

UHC New EDI Edits for MA Claims

EDI claim edits now notify you of missing or mismatched information.

As of Aug. 28, 2021, the new payer-level edits for Electronic Data Interchange (EDI) 837 claim submissions provide alerts of specific information that may be missing or doesn’t match data contained in our systems.

How will you be notified of claim issues?

Claims that are rejected for these edits will appear on your claims rejection report, also known as a 277CA report. UHC is no longer mailing letters about claim submissions that need attention. Instead, your clearinghouse will be responsible for notifying you of any issues.

What do you need to do?

Ensure you are receiving these messages from your clearinghouse. Claims that are rejected should be corrected and resubmitted electronically to be accepted into our processing system for adjudication.

KNOW YOUR TRS

This Information Pertains to POET Contracts ONLY!

Blue Choice PPO, Blue Essentials HMO, or UHC MA?

TRS Plan Name:

TRS-Care Medicare Advantage

TRS-Care Standard

TRS-ActiveCare Primary

TRS-ActiveCare Primary Plus

TRS-ActiveCare HD

TRS-ActiveCare 2

Scott and White Health Plan

South Texas HMO

West Texas HMO

POET Agreement:

UHC All Products

Blue Choice PPO

Blue Essentials HMO

Blue Choice PPO

NO

Blue Essentials HMO

Alpha Prefix or Plan:

80840

T3X

T2U

T2S

U/N

Plan Year:

2021

9/1/2021-8/31/2022

9/1/2021-8/31/2022

You will probably not see the last 3 in italics. They are regional and not offered locally.

Important Cigna CoVid Updates

Since the COVID-19 pandemic began, Cigna has taken important steps to deliver accommodations to providers and customers, helping to ensure that our customers have continued access to COVID-19 screening, testing, treatment, and vaccinations in safe settings.

Please click on the button to view this update.

Seasonal Influenza Vaccine Pricing

As posted by CMS.gov.

HealthSelect ERS

Flu Season Is Here

UHC Network News Brief 10/1/2021

Catch All the UHC UPDATES

News for BCBS Employer Groups

Sept. 24, 2021 | BCBSTX News

Vaccine Documentation Can’t be Required for Medical Treatment

The Texas Health and Human Services Commission (HHSC) is notifying practitioners who see Medicaid patients that those patients can’t be required to provide documentation of their COVID-19 vaccination status as a condition of receiving services under Texas Medicaid.

Physician Directory Update

UHC New EDI Edits for MA Claims

KNOW YOUR TRS

Important Cigna CoVid Updates

Seasonal Influenza Vaccine Pricing

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Catch All the UHC UPDATES

Sept. 24, 2021 | BCBSTX News

The Texas Health and Human Services Commission (HHSC) is notifying practitioners who see Medicaid patients that those patients can’t be required to provide documentation of their COVID-19 vaccination status as a condition of receiving services under Texas Medicaid.

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