Tag: Blue Cross Blue Shield (BCBS)

News for BCBS Employer Groups

 Author: Seymore Bones  Published Date: September 28, 2021  Leave a Comment on 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

Click here to view the full article

KNOW YOUR TRS

 Author: Seymore Bones  Published Date: September 15, 2021  Leave a Comment on 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 Essentials HMO

Blue Choice PPO

Blue Choice PPO

NO

Blue Essentials HMO

Blue Essentials HMO

Alpha Prefix or Plan:

80840

T3X

T2U

T2U

T2S

T2S

U/N

U/N

U/N

Plan Year:

2021

2021

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

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. 

Know Your TRS

PHE Current Information

 Author: Seymore Bones  Published Date: July 23, 2021  1 Comment on PHE Current Information

Follow these links to find the most current 

health plan information.

Aetna
BCBS
Cigna
UHC
Humana
PHE

Performance Blues (BCBS)

 Author: Seymore Bones  Published Date: June 30, 2021  Leave a Comment on Performance Blues (BCBS)

Has Performance given you the Blues?

I mean the Blue Cross Blues. 

If you end up among the physicians covered in a wide-ranging quality program launched by Blue Cross Blue Shield of Texas (BCBSTX), you’ll get to see your score for the first time next month.
What’s that score going to look like?

Check out the Ink File
Or head over to Texmed.org
BCBS Quality Prorgam

PEAQ Performance: Blues Program Shows Little Progress in Addressing Physicians’ Concerns 06/2021

 Author: Seymore Bones  Published Date: June 30, 2021  Leave a Comment on PEAQ Performance: Blues Program Shows Little Progress in Addressing Physicians’ Concerns 06/2021

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/06/PEAQ-Performance-Blues-Program-Shows-Little-Progress-in-Addressing-Physicians-Concerns-2021.06.pdf” download=”all” viewer=”google”]

Updated Plan Reps

 Author: Seymore Bones  Published Date: May 18, 2021  Leave a Comment on Updated Plan Reps

The  Health Plan Representative Contact List has been updated. 

Follow this tab to locate the new document in InK files.

BCBS UPDATE 5/12/2021

 Author: Seymore Bones  Published Date: May 13, 2021  Leave a Comment on BCBS UPDATE 5/12/2021

SA Modifier and Midlevel Provider Contracting Update.

On January 19, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) posted an article regarding contracting and credentialing midlevel providers and the upcoming implementation of the ClaimsXtenTM edit of the SA modifier for non-payable services resulting in the SA modifier being non-reimbursable. This edit has not been implemented and there are currently no plans for future implementation of this edit.

SA Modifier Reminder

The SA modifier should be used:

  • By the supervising physician, when he/she is billing for services rendered by a Physician Assistant (PA), Advanced Practice Nurse (APN), Certified Registered Nurse First Assistant (CRNFA) or Licensed Surgical Assistant (LSA).
  • On claims submissions by PA or APN’s when billing under their own NPI number for assisting with any other non-surgical procedures.

This information can be found in the Clinical Payment and Coding Policies – Modifier Reference Guideline located on the provider website. Information about the reimbursement amount for the SA modifier is available in the Reimbursement Schedules and Related Information (Secure Content) area of the General Reimbursement information page. You will need a password to access this information which can be obtained from your local Network Management Office location.

For the complete article, click here
SA Modifier Update

Prior Auth. Time Frames

 Author: Seymore Bones  Published Date: April 15, 2021  Leave a Comment on Prior Auth. Time Frames

Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.

Below is an overview of some payers’ COVID-19 prior authorization policies as of April 2021: Click on the Links for more detail.

Blue Cross and Blue Shield of Texas ended approvals on services with existing prior authorizations on Dec. 31, 2020. 

Aetna is approving prior authorization requests for commercial and Medicare Advantage members until the end of the plan year. “Authorization may be extended beyond the plan year, for a period of six months, if continued eligibility can be confirmed.”

Cigna resumed standard prior authorization time frames and requirements beginning April 1, 2021. 

Humana resumed standard prior authorization time frames and requirements beginning April 1, 2021

UnitedHealthcare will not require prior authorization for most services through the national public health emergency period, currently scheduled to end April 20, 2021. Exceptions include medical and behavioral health services, post-acute care admissions, site of service reviews, and transfers to new providers. Prior authorizations for medical and behavioral health were not subject to extension on or after April 10, 2020.

Article written by Ellen Terry : https://www.texmed.org/TexasMedicineDetail.aspx?id=53502&utm_source=Informz&utm_medium=Email&utm_campaign=TMT&_zs=cPrdA1&_zl=CvCF6

Prior Authorizations

Health Plan Representatives

 Author: Seymore Bones  Published Date: February 25, 2021  Leave a Comment on Health Plan Representatives

The Representative List has been updated

To View, Download or Print, please visit the InK files. 

Health Plan Representatives Updated 2/25/2021

 Author: Seymore Bones  Published Date: February 25, 2021  Leave a Comment on Health Plan Representatives Updated 2/25/2021

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/02/Health-Plan-Representatives-2021.02.25.pdf” download=”all” viewer=”google”]