Blue Cross Blue Shield – Updates to Behavioral Health Claim Review Process

From 26th August 2019 onwards, Blue Cross and Blue Shield of Texas is updating its in-house review process for behavioral health claims that need benefit preauthorization. This should be taken into consideration that updates are for the claim review process only. There is no change in Benefit preauthorization required by particular services and the process for submitting benefit preauthorization requests.
How does these changes have an impact? It must be ensured that claims are billed properly. Remember, for all claims:

• Check eligibility and benefits via an electronic 270 transaction through the Availity's Provider Portal or any preferred vendor portal for each patient before rendering services. This will help in determining if benefit preauthorization is required.
• Before providing services get the benefit preauthorization if there is any required.
• In order to help expedite claim payments it is necessary to bill industry standard codes.

This claim review process is not applicable for claims submitted for HMO, Government Programs or Federal Employee Program members.