| Reimbursement Changes and Updates |
|
| BCBSTX Relative Values |
Assistant Surgery allowable is 20% of the Surgery rate. Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists and Nurse Midwives will be reimbursed 85% of the rates posted on the internet except for Drugs, Clinical Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Durable Medical Equipment/ Prosthetics and Orthotics will be reimbursed at 100% of the rates posted on the internet. |
Facility Relative Values
|
| Clinical Laboratory |
Professional component for procedures listed on the Clinical Lab Schedule will be reimbursed at $5.00 for HMO and $5.50 for PPO. Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount. |
|
| Durable Medical Equipment/Prosthetics and Orthotics |
Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount. |
|
| Drugs |
Note: The Drug/Injectable Fee Schedule will be updated on the following dates: 6/1/2008, 9/1/2008, 12/1/2008, 3/1/2009 and 6/1/2009. Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.
|
| Other Codes |
Assistant Surgery allowable is 20% of the Surgery rate. Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists and Nurse Midwives will be reimbursed 85% of the rates posted on the internet except for Drugs, Clinical Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Durable Medical Equipment/ Prosthetics and Orthotics will be reimbursed at 100% of the rates posted on the internet. Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount. |
|
| Multiple Imaging Procedure Reduction – Technical Component |
|
-
- Home
- Network Participation
Network Participation
- Claims and Eligibility
Claims and Eligibility
- Claims and Eligibility
- BlueCard Program
-
Electronic Commerce
- Eligibility and Benefits
-
Utilization Management
- Prior Authorization Services For Fully Insured and ASO
- Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO)
- Prior Authorizations Lists for Designated Groups
- Recommended Clinical Review Option
- Prior Authorization Exemptions (Texas House Bill 3459)
-
Claims Filing Tips
- Claim Status
- Claim Review Process
- Interactive Voice Response (IVR) System
- Education and Reference Center
- Clinical Resources
Clinical Resources
- Clinical Resources
- Alacura Medical Transportation Management.
- Behavioral Health Care Management Program
- Carelon
- Clinical Practice Guidelines
- eviCore Prior Authorization Program
-
Health Equity and Social Determinants of Health (SDoH)
- Preventive Care Guidelines/Patient Wellness Guidelines
-
Quality Care – Partner With Your Patients
- Quality Improvement Tip Sheet
- Special Beginnings - Maternity Program
- Telemedicine and Telehealth Services
- Pharmacy Program
- Standards and Requirements
Standards and Requirements
- Standards and Requirements
-
Affordable Care Act (ACA)
-
Clinical Payment and Coding Policies
-
Consolidated Appropriations Act and Transparency in Coverage Final Rule
- Disclosure Notices
- Federal Employee Program (FEP)
-
General Reimbursement Information
-
Manuals
- Medical Policies
- Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members
- PEAQ - Physician Efficiency, Appropriateness, & Quality Program
- Employers
- Producers
- Providers
- Company Information