Blue Cross Blue Shield

Blue Cross Says MOC Not Needed for BlueCompare - 02/28/2024

Physicians across the state reacted strongly to a March 5 letter from Blue Cross and Blue Shield of Texas (BCSTX) that implied the state’s largest insurance company is now using maintenance of certification (MOC) to rate physicians. That was not the intent, the company’s president says.

Blues to Expand HMO Network in January; Check Your Status - 10/21/2022

Blue Cross and Blue Shield of Texas (BCBSTX) will expand its MyBlue Health HMO network to six Texas counties starting in January.

Blue Cross Bundles Payment for Some Diagnostic Services - 11/16/2020

Effective July 1, Blue Cross and Blue Shield of Texas will cut payments for certain diagnostic procedures. The cut will apply to diagnostic cardiovascular and ophthalmology procedures that are billed for the same patient on the same day.

Blue Cross HMO Emergency Payment Review Policy Begins - 11/16/2020

Beginning today, Blue Cross Blue and Shield of Texas will require some members to pay 100 percent of their medical bills if they go to an out-of-network emergency room for certain non-life-threatening conditions, company officials have confirmed.

See Blue Cross Referral Chart, Colonoscopy Coding Tips - 10/14/2020

As a result of “feedback from the provider community,” Blue Cross and Blue Shield of Texas has removed 111 procedure codes from its preauthorization requirements related to additional care categories of codes.

Blue Cross Prior Authorization Manager Changing - 09/30/2020

Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.

Charging Concierge Fees to BCBSTX Patients - 09/23/2020

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.

TDI Fines Blue Cross $10 Million for Delays, Errors - 03/11/2020

Blue Cross and Blue Shield of Texas will pay a $10 million fine for providing consumers incorrect information, delays in out-of-network claims processing, and errors in marketing materials, the Texas Department of Insurance has announced.

Dos and Don’ts of Using Modifier 22 - 04/25/2019

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.

Expect HEDIS Records Requests From Third Parties - 02/28/2019

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas or UnitedHealthcare, it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.

Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.

Blue Cross to Put Off HMO Emergency Coverage Policy Until August - 06/27/2018

Blue Cross and Blue Shield of Texas will delay for 60 days a new HMO emergency care policy it had originally planned to begin on Monday, June 4.

Submitting Med Records, and More Tips From Blue Cross - 06/26/2018

Here’s some news you can use from Blue Cross and Blue Shield of Texas.

TMA Seeks TDI Review of Blue Cross HMO Emergency Policy - 05/10/2018

The Texas Medical Association and 18 other Texas medical societies are asking the Texas Department of Insurance to review a new Blue Cross Blue Shield of Texas policy that could require some HMO members to pay 100 percent of their out-of-network emergency medical bills.

Some Blue Cross Members Could Pay 100 Percent of ER Bill - 05/01/2018

The Texas Medical Association has reached out to Blue Cross and Blue Shield of Texas to obtain more details on a new HMO emergency care policy at BCBSTX unveiled this week.

UHC Termination Date Correction, BCBSTX EFT Error - 04/20/2018

When checking eligibility for HealthSelect of Texas (Employees Retirement System) members, practices may see two lines of coverage.

Blue Cross Targeting Modifier 50 Misuse - 04/19/2018

Beginning April 1, 2012, Blue Cross and Blue Shield of Texas (BCBSTX) will pursue overpayments it made for claims wrongly billed with modifier 50.

Use Health Plan Policies to Avoid Denied Claims - 04/19/2018

Coverage policy, medical policy, clinical policy, reimbursement policy … health plans’ policies are the guidelines they use to help decide what services and procedures they consider medically necessary and how they will — or will not — pay for them.