Tag: Blue Cross Blue Shield (BCBS)
BCBSTX AND CHI UPDATE
POET has received an update from BCBSTX regarding CHI.
“CHI is not going out of network. Your providers that only have CHI for hospital privileges will be good.”
Health Plans in Texas Have Adopted Various Temporary Deadlines and Extensions as Part of Their Coronavirus Policies, TMA 1/5/21
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/01/Health-Pans-in-Texas-with-Various-Temporary-Deadlines-2021.01.15.docx” download=”all” viewer=”microsoft”]
Clash of the Titans? CHI vs BCBSTX
BCBSTX and CHI (CommonSpirit) are clashing over their contract.
CHI has given termination notice to BCBSTX. The termination is effective after December 16, 2020 according to a letter received from BCBSTX.
This termination will affect physicians with privileges ONLY at CHI hospital and not with another in network facility. This is because physicians are required to have privileges with an in network facility.
If you also are “on staff” at Woodland Heights or another in network facility this does not affect your credentialing with BCBSTX.
Physicians may reach out for privileges with other in network facilities OR Physicians may have arrangements for care of their patients at other in network facilities if necessary.
POET has not mentioned this before because most of the time these situations are resolved at the last minute. We believe both parties need each other and therefore will find a solution.
We have had a few calls asking what physicians can do. Since BCBSTX has state employees, we suggested reaching out to your legislators. It seems unfair for patients and physicians to be caught in the middle of the clash of the titans.
AIM Specialty Health (AIM) to Perform Utilization Management for:
Participants with three-character prefixes of T2U and T2S (Group #3850X -last digit varies by plan) who are under 65 years of age and are active employees.
This is referring to TRS ActiveCare Patients.
To log in to “AIM” click the blue text.
To review the “AIM” training slide deck, click here.
UPCOMING Provider/Portal Training Dates
- Advanced Imaging & Cardiology: Tuesday, Sept. 15 (10 AM-11 AM)
- Sleep Medicine: Wednesday, Sept. 16 (12 PM-1 PM)
- Joint and Spine Surgery:Thursday, Sept. 17 (12 PM-1PM)
- Pain Management: Tuesday, Sept. 15 (9 AM-10 AM)
- Radiation Therapy: Thursday, Sept. 17 (3 PM-4PM)
- Genetic Testing Services: Tuesday, Sept. 15 (12 PM -1 PM)
Welcome to Blue Cross and Blue Shield of Texas (BCBSTX) Provider Orientation Information
On May 13, we announced we were awarded the contract to administer medical and behavioral health benefits for the Teacher Retirement System of Texas (TRS), effective Sept. 1, 2020. TRS-ActiveCare participants will be offered health plans that use either the nationwide Blue Choice PPOSM or statewide Blue EssentialsSM provider networks.
TRS-ActiveCare Plans
Statewide Blue Essentials network – providers who are contracted under the Blue Essential network can see participants on these plans:
- TRS-ActiveCare Primary and TRS-ActiveCare Primary+
- Copays for doctor visits before meeting deductibles.
- Primary care provider (PCP) selection and referrals to specialists are required.
- No out-of-network coverage, except for true emergencies.
Nationwide Blue Choice PPO network plans – providers who are contracted under the Blue Choice PPO network can see participants on these plans:
- TRS-ActiveCare HD
- High deductible plan which may include a health savings account (HSA) to pay for medical care.
- Does not require PCP selection or referrals.
- Deductibles must be met before the plan pays for diagnostic care.
- Includes out-of-network coverage. Participants have a lower cost share when using in-network providers.
- TRS-ActiveCare 2
- Copays for doctor visits before meeting deductibles.
- Does not require PCP selection or referrals.
- Includes out-of-network coverage. Participants have a lower cost share when using in-network providers.
Identifying TRS-ActiveCare Participants
TRS-ActiveCare participants can be identified by the following on their BCBSTX ID card:
- The TRS-ActiveCare logo will be displayed on the participants’ ID card.
- TRS-ActiveCare Primary and TRS-ActiveCare Primary+ plan holders will have ID cards with a three-character prefix of T2U.
- TRS-ActiveCare HD and TRS-ActiveCare 2 plan holders will have ID cards with a three-character prefix of T2S and a network ID of BCA.
For patients on TRS-ActiveCare Primary and TRS-ActiveCare Primary+, you must be their assigned provider to provide primary care services. Patient eligibility and benefits should be checked using Availity® or your preferred vendor before every scheduled appointment. Eligibility and benefit quotes include patients’ coverage status and other important information, such as applicable copays, coinsurance and deductibles. It’s strongly recommended that providers ask to see patients’ ID card and photo ID to guard against medical identity theft. If services may not be covered, patients should be notified that they may be billed directly.
Prior Authorization
You can check the Prior Authorization and Predeterminations page for the list of Administrative Services Only (ASO) services and procedure codes that require prior authorization for TRS participants. Refer to How to Submit a Prior Authorization or Prenotification to learn about submission processes.
Reminders
TRS will continue to use CVS Caremark as their pharmacy benefit manager. We encourage you to attend provider training sessions related to TRS-ActiveCare benefits, prior authorization requirements and ID cards. Continue to watch News and Updates and our Blue Review newsletter for more details on TRS-ActiveCare.
If you have any questions, please contact your BCBSTX Network Management Representative.
As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if prior authorization is required for a participant. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.
Please note that checking eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits are not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things the participant’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
Click to view the training declk “AIM Provider Training for Prefixs T2U and T2S”
Click to view the training slide deck called “Introduction to TRS-ActiveCare”
TRS, Selection of PCP, Help
Below are two screenshots with notes that may help you field calls today. They are taken from the BCBS/TRS Employee Website: https://www.bcbstx.com/trsactivecare/doctors-and-hospitals
BCBS Expands Telemedicine through 12/31/2020
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/08/08142020-Update-on-Telemedicine-Expansion.pdf” download=”all” viewer=”google”]
TRS- AIM Provider Training for Prefixs T2U and T2S 08/05/2020
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/08/TRS-AIM-External-Training-for-Providers-Final-8-5-2020.pdf” download=”all” viewer=”google”]
Introduction to TRS – ActiveCare 08/05/2020
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/08/Introduction-of-TRS-ActiveCare-and-Prior-Authorization-Expansion-Final-8-5-2020.pdf” download=”all” viewer=”google”]
Have you signed up for the TRS training?
Two dates left !
| Provider Webinar Training Select the link of the session you would like to attend. Complete the registration. Check for confirmation email with instructions on how to join. Space for the online training is limited. If you received a notice that the Webinar you chose is full, please choose another option. |
Wednesday, August 19, 2020 1:00 pm | Central Daylight Time Wednesday, August 26, 2020 10:00 am | Central Daylight Time |
To view the slide decks:
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