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Medical and pharmaceutical policies help determine benefits coverage. Explore policies and drafts in process.
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- COVID-19 Preparedness
- COVID-19 Related News
- COVID-19 Provider Information for ERS Participants
- Blue Review
- 02/23/22 Reminder: Claim Editing Enhancements Coming April 1
- 02/22/22 New Medicare Advantage Flex (PPO) Plan
- 02/21/22 CMS Payment Adjustments for Medicare Providers
- 02/18/22 Differential Diagnoses of Depression
- 02/18/22 Closing Gaps in Care for Group Medicare Advantage Members
- 02/04/22 BCBSTX 2021 Employee Volunteer of the Year
- 02/02/22 CPCP024 Evaluation & Management Coding - Professional Services Update
- 02/01/22 Supporting Healthy Hearts
- 01/31/22 CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Revised
- 01/31/22 New Laboratory Management Program & Related Clinical Payment and Coding Policies to Begin on May 1, 2022
- 01/28/22 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2022 – Part 1
- 01/28/22 It’s Time! Verify Your Directory Details
- 01/24/22 Update: Prime Therapeutics LLC Accepting Network Participation Bids Until 4/20/22
- 01/18/22 Surprise Billing Provisions of No Surprises Act
- 01/18/22 Prime Therapeutics LLC to Accept Facility Pharmacy Network Participation Bids
- 01/14/22 CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Update
- 01/14/22 Clinical Payment and Coding Policy Updates from Annual Reviews
- 01/12/22 Cervical and Breast Cancer Screenings
- 01/10/22 Pneumatic Compression Devices – Outpatient Use Update
- 01/10/22 ClaimsXtenTM Quarterly Update Effective April 1, 2022
- 01/10/22 Pharmacy Updates eff 1/1/2022 Part 2
- 01/10/22 Claim Editing Enhancements Coming - Register for a Training Webinar
- 01/10/22 Federal Employee Program Annual Medical Record Data Collection for HEDIS® Quality Reporting
- 01/10/22 Annual Medical Record Data Collection for Quality Reporting begins Feb. 1
- 12/30/21 Blue Cross Medicare AdvantageSM Prior Authorization Code Update Effective April 1, 2022
- 12/30/21 CPCP006 Preventive Services Policy Update 01/01/2022
- 12/28/21 Update: New Lab Policies and Laboratory Management Program Delayed
- 12/28/21 Prior Authorization Code Update Effective 4/1/22 for Commercial Members
- 12/28/21 Claim Editing Enhancements Coming April 1, 2022
- 12/27/21 CPCP027 Inpatient Readmissions Update
- 12/23/21 New Look Ahead for Provider Website
- 12/22/21 CPCP018 Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT, HCPCS and/or NDC Codes Update
- 12/17/21 2022 Federal Employee Program® Prior Authorization and Benefit Updates
- 12/17/21 CPCP003 Emergency Department Evaluation and Management (E/M) Services Coding – Facility Services
- 12/17/21 Availity® Tools to Support Providers in 2022
- 12/16/21 Chiropractic & Mixed Therapy Benefits Contained in IVR Phone System as of Jan. 3, 2022
- 12/14/21 Medicare Advantage Provider Manual Supplements Update!
- 12/13/21 Webinar on Avoiding Antibiotics Overuse
- 12/09/21 Update to Provider Information on COVID-19 Coverage
- 12/08/21 Rural Health Clinics and Federally Qualified Health Centers May Meet Quality Measure
- 12/08/21 Qualified Medicare Beneficiary Program Patients Should Not Be Billed
- 12/08/21 Hospitals Must Provide Medicare Outpatient Observation Notice
- 12/08/21 Update: Blue Cross Medicare Advantage Annual Health Assessment (AHA) Incentive
- 11/25/21 COVID-19 Vaccine Billing for Medicare Advantage Members
- 11/25/21 New Flexible Medicare Advantage PPO Plan
- 11/24/21 CPCP005 Coordinated Home Care /Private Duty Nursing Policy
- 11/23/21 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 1
- 11/22/21 CPCP011 Applied Behavioral Analysis
- 11/22/21 CPCP036 Paravertebral Facet Injection Procedure Coding & Billing Policy
- 11/19/21 Revision to Prior Authorization Codes for Commercial Members
- 11/19/21 New Information on Member ID Cards
- 11/18/21 Machine-Readable Files
- 11/18/21 Surprise Billing Provisions of No Surprises Act
- 11/17/21 Provider Directory Information Verification
- 11/17/21 Referral Submission Tips
- 11/17/21 The Magellan Connection: Partnering with PCPs
- 11/16/21 Coronavirus (COVID-19) Provider Information for ERS Participants
- 11/12/21 2022 Blue Cross Medicare Advantage Expansion Service Areas
- 11/12/21 Single Sign-On Access to AIM Specialty Health® via Availity®
- 11/11/21 View Withdrawn Claim Descriptions via the Availity® Claim Status Tool
- 11/10/21 Annual HEDIS/QRS Reports
- 11/09/21 CPCP017 Wasted/Discarded Drugs and Biologicals Policy Update
- 11/09/21 Magellan's Webinar Series: Improve patient outcomes with these quality measures
- 11/08/21 Fighting Fraud, Waste and/or Abuse
- 11/06/21 CPCP020 Drug Testing Policy Revised Inactive Date
- 11/06/21 CPCP037 Lab Management Program Effective Date Change
- 11/05/21 Encourage Early and Timely Intervention for Pre-and Post-Partum Care
- 11/04/21 Preventive and Follow Up Colonoscopies
- 11/03/21 Continuity of Care Changes
- 11/02/21 Webinar on Avoiding Antibiotics Overuse
- 10/29/21 Hospital Discharge Summaries Empower Members and Inform Providers
- 10/29/21 Coordinated Home Care & Home Infusion Therapy Prior Authorizations Reminders
- 10/28/21 ERS Coronavirus (COVID-19) Provider Information Update
- 10/28/21 Health Benefits of Collaborating with Eye Care Professionals
- 10/27/21 CPCP009 Co-Surgeon/Team Surgeon Modifiers
- 10/26/21 Depression Disorder Prescribing
- 10/25/21 Consolidated Appropriations Act & Transparency in Coverage Final Rule
- 10/25/21 Streamlining Coordination of Benefits for Members with Secondary Coverage
- 10/22/21 Depression and Diabetes
- 10/19/21 Catch Up on Vaccines for All Ages
- 10/18/21 Introducing Electronic Clinical Claim Appeal Requests via Availity®
- 10/12/21 CPCP029 Medical Record Documentation Guidelines
- 10/11/21 Claim Editing Enhancements Coming Jan. 10, 2022
- 10/07/21 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021 -Part 2
- 10/07/21 Avoiding Antibiotics for Acute Bronchitis
- 10/07/21 CPCP035 Unlisted/Not Otherwise Classified Coding Policy
- 10/04/21 New Prior Authorization Lists for Blue Cross Medicare AdvantageSM January 1, 2022
- 10/01/21 BCBSTX Making It Easier to Transfer Members to Post-Acute Care
- 09/30/21 CPCP006 Preventive Services Policy Updates
- 09/29/21 Update to Prior Authorization Codes for Commercial Members
- 09/29/21 New Laboratory Program Coming Jan. 1
- 09/27/21 CPCP010 Anesthesia Clinical Payment and Coding Policy Update
- 09/27/21 Update: Replacement for CHANTIX® Smoking Cessation Product Recall
- 09/21/21 Initiating and Engaging Patients in Treatment for Alcohol and Drug Dependence
- 09/17/21 CPCP026 Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding
- 09/17/21 CPCP019 Home Infusion
- 09/16/21 2022 Telemedicine and Telehealth Services
- 09/16/21 Delivering Quality Care - Managing Diabetes
- 09/15/21 Delivering Quality Care - Breast Cancer Screening
- 09/15/21 Update: COVID-19 Vaccines and Coverage
- 09/13/21 MyBlue Health Network Expansion
- 09/10/21 Change to Some Primary and Secondary Claims Coordination
- 09/09/21 Facility Based Provider Onboarding Process
- 09/07/21 Reminder: Medical Oncology Prior Authorization Update
- 09/07/21 Cancer and Cancer Related Treatments Coding
- 09/07/21 Training for Pharmacy Medical Oncology Through AIM®
- 09/06/21 Shared Decision-Making Aids 2021
- 09/01/21 Free Webinar: A Discussion on Vaccine Process Improvement
- 08/31/21 CPCP020 Drug Testing Policy Update
- 08/31/21 CPCP015 Multiple Surgical Procedures-Professional Provider Services
- 08/25/21 Update: COVID-19 Initiatives Extended
- 08/25/21 Reinstated Interfacility Transfer without Prior Authorization Accommodation
- 08/24/21 CPCP037 Lab Management Program
- 08/23/21 MyBlue HealthSM Expands in 2022
- 08/20/21 HealthSelect of Texas® Prior Authorization Procedure Code Update
- 08/20/21 Earn CME/CEU Credit at Free Webinar on Comorbid Conditions
- 08/19/21 Training for Pharmacy Medical Oncology Through AIM®
- 08/12/21 Blue Cross Medicare Advantage Annual Health Assessment (AHA) Incentive
- 08/12/21 CPCP034 Unbundling Policy – Professional Providers
- 08/11/21 Updates to Clinical Practice and Preventive Care Guidelines
- 08/11/21 ClaimsXtenTM 4th Quarter 2021 Update
- 08/11/21 Obesity and Morbid Obesity Documentation and Coding
- 08/10/21 CPCP021 Laboratory Panel Billing - Update
- 08/10/21 CPCP032 Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline
- 08/06/21 New Specialty Pharmacy for Pharmacy Members as of Aug. 1A
- 08/06/21 Pharmacy Members Have a New Mail Order Pharmacy as of August 1
- 08/04/21 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021 – Part 1
- 08/04/21 Availity® Claim Status Response Enhancement for Blue Cross Medicare Advantage Claims
- 08/02/21 CPCP001 Observation Services Policy Updated
- 08/02/21 Additional Update to Prior Authorization Codes for Commercial Members – 10/1/2021
- 07/29/21 Important Information About Participants Transitioning to HealthSelect of Texas®
- 07/21/21 Select Medication List to be Updated Nov. 1, 2021
- 07/16/21 Update Your Information
- 07/13/21 Adhere to HPV and Shingles Vaccine Guidelines
- 07/09/21 Prior Authorization Update - Medical Oncology
- 07/05/21 Colorectal Cancer Screening for Members Age 45 to 75
- 07/01/21 10/1/2021 Update to Prior Authorization Codes for Commercial Members
- 07/01/21 CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services - Revision
- 07/01/21 Antidepressant Medication Management
- 06/30/21 Update to Prior Authorization Codes for Medicare Members
- 06/29/21 CPCP012 Hernia Repair Updated
- 06/25/21 CPCP006 Preventive Services Policy Update
- 06/24/21 Register Now: July - September Indices Training
- 06/18/21 Free Vaccine Confidence Webinar
- 06/16/21 Update to Room Rate Notification Form
- 06/14/21 Update to AIM Prior Authorization Codes for Commercial Members
- 06/11/21 Closing Gaps in Care for Group Medicare Advantage (MA) Members
- 06/11/21 Supporting Mental Health
- 06/10/21 CPCP021 Lab Panel Billing & CPCP030 Point-of-Care Ultrasound Exams Updated
- 06/10/21 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2021 – Part 2
- 06/07/21 Importance of Complete Discharge Summaries
- 06/06/21 Earn CME/CEU Credit at Free Webinar on Opioid Use
- 06/02/21 Prior Authorization Update – Code 64640
- 05/31/21 HMO Plan PCP Selection and Referrals Update
- 05/31/21 In-Home Test Kits for Colorectal Cancer Screening
- 05/28/21 Update to Billing information on free bamlanivimab
- 05/27/21 Update: Professional Provider Fee Schedule via Availity®
- 05/25/21 SA Modifier and Midlevel Provider Contracting Update
- 05/24/21 ClaimsXtenTM Update to Procedure Codes
- 05/24/21 CPCP014 Global Surgical Package Updated
- 05/24/21 CPCP031 Trauma Activation
- 05/21/21 CPCP023 Modifier Reference Guideline - Update
- 05/21/21 Medicare Sequester Suspended Through Dec. 31, 2021
- 05/21/21 New Resources Added to Wellness Can’t Wait Page
- 05/20/21 Catch Up Now on Child and Adolescent Vaccinations
- 05/20/21 Fraud Prevention and Reporting
- 05/19/21 New Location for Utilization Management on Provider Website
- 05/14/21 CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Update
- 05/13/21 Update to COVID-19 Telehealth Expiration Date for ERS
- 05/13/21 Free CME Webinar on Depression
- 05/12/21 Treating Substance Abuse
- 05/12/21 SA Modifier and Midlevel Provider Contracting Update
- 05/11/21 CPCP013 Increased Procedural Services Updated
- 05/08/21 Reminder: Use Availity for EFT and ERA Enrollments
- 05/08/21 Keys to Diabetes Management
- 05/07/21 Register Now: Discussing HPV with Parents of Adolescents Webinar
- 05/06/21 Prepayment Reviews on BlueCard Inpatient DRG Claims
- 05/06/21 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2021 – Part 1
- 05/03/21 Professional Provider Fee Schedule via Availity®
- 04/30/21 Update to Prior Authorization Codes For Commercial Members
- 04/30/21 Update to Prior Authorization Codes for Medicare and Medicaid Members
- 04/28/21 Update to Telemedicine Code List
- 04/17/21 CERiS to Review Complex Claims
- 04/14/21 Major Depressive Disorder Documentation & Coding Guideline
- 04/14/21 Access to Resources to Support Quality Care
- 04/10/21 CPCP023 Modifier Reference Guideline Update
- 04/09/21 CPCP029 Medical Record Documentation & CPCP008 Psychological & Neuropsychological Testing Update
- 04/09/21 TXCPCP03 Surgical and Non-Surgical Services Guide
- 04/08/21 Provider Satisfaction Survey 2021
- 03/31/21 New Applied Behavior Analysis (ABA) Service Request Forms
- 03/30/21 CPCP006 Preventive Services Policy Update
- 03/30/21 Labs for Prompt COVID-19 Testing
- 03/26/21 CPCP033 Telemedicine and Telehealth Services Update
- 03/26/21 Update to CPCP028 - Non-Reimbursable Experimental, Investigational and/or Unproven Services
- 03/23/21 April Trainings for Indices Reporting
- 03/20/21 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 – Part 2
- 03/19/21 Caring for the Colon
- 03/19/21 Cervical Cancer Screening May Save a Life
- 03/19/21 Hospitals and Routine Services and Supplies
- 03/19/21 Medical Necessity Review of Observation Services
- 03/18/21 Reminder: Commercial Plan Appeals Process for 2020 eviCore® Adverse Determinations
- 03/17/21 Reminder Submit EFT and ERA Enrollments via Availity
- 03/11/21 COVID-19 Vaccines and Coverage
- 03/09/21 Register Now: TRS Physician-Directed Health Plans Lunch and Learn
- 03/05/21 Some Codes Removed from AIM® Prior Authorization
- 03/05/21 Update: COVID-19 Initiatives Extended
- 03/05/21 Update: Expired - Making It Easier to Transfer Members to Post-Acute Care
- 03/04/21 Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM Annual Health Assessment (AHA) Incentive
- 03/04/21 The CAHPS® Survey: We All Play a Role
- 03/02/21 Speaking Out About the ‘Silent Killer’
- 03/01/21 Telemedicine Expansion for 2021
- 03/01/21 Multiple Procedure Payment Reduction Claims Review
- 02/26/21 Single Access Point for 835 EFT and ERA Enrollments
- 02/25/21 Blue Essentials AccessSM and Blue Premier AccessSM Plan Reminder
- 02/24/21 Register for Indices Training: Learn How it Can Help You Close Care Gaps
- 02/23/21 COVID-19 Preparedness: Emergency Room Testing and Collection, Lab and Diagnosis Codes Update
- 02/20/21 Professional Provider Insurance Liability Limits
- 02/15/21 Overpayment of Multiple Surgical Procedures
- 02/15/21 CPCP004 NICU Policy – Correction
- 02/12/21 CPCP033 - Telemedicine and Telehealth Policy Update
- 02/11/21 Predetermination of Benefits List
- 02/11/21 Get the Conversation Started on Colorectal Cancer
- 02/11/21 Prevention is Still Important During the COVID-19 Pandemic
- 02/09/21 System Issue Sending Incorrect Provider Term Notice to Members
- 02/09/21 CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) - Effective 05/15/2021
- 02/04/21 CPT Category II Codes Can Help Close Care Gaps
- 02/04/21 Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 – Part 1
- 02/03/21 Telemedicine FAQs
- 02/02/21 Terming PFINs No Claims
- 01/29/21 Updated: Telehealth 2021 - Telehealth Claims
- 01/29/21 Telehealth Claim Place of Service
- 01/25/21 Availity System Error and Erroneous PCP Number Assignment for Blue Cross Medicare Advantage HMOSM
- 01/22/21 COVID-19 Preparedness: Pharmacy and Testing Before Non-COVID-19 Treatment Update
- 01/19/21 COVID-19 Preparedness: Testing and Treatment, Telemedicine/Telehealth and Vaccine Update
- 01/19/21 Contracting and Credentialing Midlevel Providers
- 01/18/21 Atrial Fibrillation and Diabetes Mellitus - Documentation & Coding Guidance
- 01/15/21 Updated: Telehealth 2021 - Intensive Outpatient Program (IOP) Telehealth Coverage
- 01/14/21 Preventive Services Clinical Payment and Coding Policy Update
- 01/13/21 Blue Cross Medicare Advantage Provider Quick Reference Guide
- 01/13/21 Medical Record Data Collection for Quality Reporting begins February 1, 2021
- 01/13/21 2020-21 Preventive Care Guidelines Are Available
- 01/08/21 Notification of Annual Benefit Updates
- 01/05/21 Telehealth 2021
- 01/05/21 Patients in the Qualified Medicare Beneficiary (QMB) Program Should Not Be Billed
- 01/05/21 Hospitals Must Provide Medicare Outpatient Observation Notice
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