Tag: Blue Cross Blue Shield (BCBS)

August 4th – UPDATE ON PHYSICIANS BEING LOADED FROM BCBSTX BELOW:

“I’m working on getting the providers loaded asap.  I don’t know exactly when they will be loaded but I have requested them to be loaded as urgent and will notify you as soon as that’s done so that members can select their Primary Care Physicians.”

The following memo is for POET physicians participating in POET Blue Essentials contract with BCBSTX. Bottom line is if you do not wish to see ANY Blue Essentials member please contact POET. Otherwise you are now completely in the Blue Essentials product (unless there are carved out benefit plans. )

As you may be aware TRS will have an option of Blue Choice or Blue Essentials as of September 1, 2020.

Currently our Blue Essentials agreement only allows for ERS through the definition of Member.

To add TRS and other members, the definition of Member has been changed to:

“Blue Essentials Member (“Member”) means an individual who is eligible to receive Covered Services under a Health Plan that utilizes the Blue Essentials HMO Network. “

This means you will be in network possibly (always check benefits) for ANY patient with Blue Essentials.

If you do not wish to participate in the agreement with this change, please contact POET to request a “opt out” form to sign.

HOW TO LEARN MORE:

BCBSTX is offering webinars to help educate you and your staff about Blue Essentials.  See the below link for more information.

Link to BCBSTX article: https://www.bcbstx.com/provider/providersearch.html?keyword=TRS&state=tx&portal=&collectionType=tx_prod_provider&x=10&y=4

As always if you have questions please feel free to contact POET.

UPDATE: BCBSTX has sent the following reply to POET asking when physicians would show up in website as in network:

“To answer your questions providers can be loaded into the system prior to the effective date; however, they will not be visible for members select on the website until the date the contract takes effect.”

BCBSTX has sent the following message:

” I am hearing from providers that hold times are long right now, so if you hear that from your physicians they are still working on getting everyone access. “

Behavioral Health Program Changes for Some Provider Networks (Corrected)

Starting June 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will administer behavioral health benefits for members enrolled in our Blue EssentialsSM, Blue Essentials AccessSM, Blue PremierSM and Blue Premier AccessSM provider networks. Magellan Healthcare® will no longer administer behavioral health benefits for these members.

Please forgive us for a double post. The original letter from BCBS (posted 2/27/20) left out HealthSelect. To read the corrected article please follow this link.

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/03/Behavioral-Health-Program-Changes-030120020-1.docx” download=”all” viewer=”microsoft”]

As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. 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 verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’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 member’s ID card.

Availity is a trademark of Availity, L.L.C., 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 offered by Availity, Aerial or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.

There are important changes to the prior authorization requirements for the HealthSelect of Texas and Consumer Directed HealthSelect plans administered by BCBSTX. The list of services requiring prior authorization has not changed; however, beginning March 1, 2020, prior authorizations for services previously managed by eviCore healthcare^® will now be managed through BCBSTX.

For more information visit the BCBS file.

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/02/HealthSelect-Prior-Auth-Transition-Provider-Communication-02242020.docx” download=”all” viewer=”microsoft”]

In case you do not realize it, POET works hard to get information out to you as quickly as possible. In our rush to get the March 1, 2020 updated fee schedule to you – we left out the “Opt in/out” form!

We are emailing the forms to you today! If you do not receive one please notify us!

Look for your “Opt-in/out” packet from POET next week. POET has been receiving bits and pieces of the fee schedule this week.

The update is effective March 1, 2020.

BCBSTX notified POET of a new fee schedule effective March 1, 2020 a few months back. POET will provide you with the new schedule when BCBSTX provides it to us.

yep…still waiting…..