|October 26, 2012 |
For Travis Service-Area Medicaid & CHIP Providers
Welcome to the Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR) & CHIP weekly newsletter. Thank you for participating in BCBSTX Medicaid (STAR) & CHIP programs.
Nov. 6, 2012 – Provider Orientation: Comprehensive Overview
Look for more details in the next edition of Blue Cross and Blue Shield of Texas Medicaid provider newsletter.
Over-the-counter items are included if on the Preferred Drug List (PDL) and require a prescription to be processed for reimbursement. Prenatal pills can be purchased OTC but can also be prescribed by an OB/GYN. If prescribed by an OB/GYN, Express Scripts, the pharmacy administrator, can be billed. This benefit is only covered for Medicaid (STAR). CHIP and CHIP Perinate members are not eligible for this benefit.
After-Hours Accessibility Surveys
BCBSTX will conduct quarterly phone surveys of primary care providers (PCPs) during November. The purpose of the survey is to ensure that PCPs are available to BCBSTX members 24 hours per day, seven days per week. PCPs who do not answer their office telephone after normal business hours must have an answering service, an answering machine or another provider answering calls. Both the Texas Health and Human Services Commission (HHSC) and Texas Department of Insurance (TDI) require all managed-care organizations to monitor after-hours accessibility periodically, but no less than annually. PCPs should inform their staff and answering service they may receive a phone call from a BCBSTX representative in November between 6 p.m. and 9 a.m. The brief survey measures each provider’s availability to be reached by BCBSTX members after-hours.
Acceptable after-hours call coverage arrangements are:
The following are considered unacceptable after-hours call coverage arrangements:
- The office telephone is answered after normal business hours by an answering service which can contact the PCP or another designated medical practitioner. The PCP or his/her designee must be available to return calls answered by the answering service within 30 minutes.
- The office telephone is answered after normal business hours by a recording directing the member to call another number to reach the PCP or another designated medical practitioner. Someone must be available to answer the designated provider’s telephone. Another recording/answering machine is not acceptable.
- The office telephone is transferred after normal business hours to another location, where a live person answers the phone and can contact the PCP or another designated medical practitioner.
- The PCP or his/her designee must be available to return calls within 30 minutes.
- The office telephone is not answered after normal business hours.
- The office telephone is answered after normal business hours by a machine that instructs members to leave a message.
- The office telephone is answered after normal business hours by a machine that instructs patients to go to the emergency room.
- Messages or pages are not returned within 30 minutes.
Have you moved into a new office recently? Changed your telephone number? Do you have patients with missed appointments or arriving late for appointments?
If you answered yes to any of these questions, please take a minute to confirm your address and phone number at the websites listed below:
Medicaid (STAR): http://www.bcbstx.com/pdf/star_pro_dir.pdf
If a change is necessary, send the correct information via email or fax to BCBSTX Medicaid at the contact information listed at the end of the newsletter. Also update Texas Medicaid and Healthcare Partnership (TMHP) via the Provider Information Change Form available at: http://www.tmhp.com/Provider_Forms/Provider%20Enrollment/Provider-Information-Change-Form.pdf and the Health and Human Services Commission's administrative services contractor.
Thank you for taking the time to verify your information and for the service you provide to BCBSTX Medicaid (STAR) & CHIP members.
Value Added Services Effective Sept. 1, 2012
BCBSTX Value Added Services are directed at improving the health of pregnant women through increasing access to preventive care. It is important for OB/GYN providers to be aware of services and how they can request or refer clients for these services. Clients can be directed to contact Customer Service at 888-292-4480.
Value Added Services effective Sept. 1, 2012:
For more information on any of these Value Added Services, please review our Medicaid (STAR) and CHIP Value Added Services Training located at http://bcbstx-uat.fyiblue.com/pdf/value_added_training.pdf.
- Infant safety car seats
- Free pregnancy classes
- Home wellness visits (for mom and baby post-delivery)
- Free breast pump and breast feeding coaching
- Austin Farmers’ Market vouchers (fresh fruit and vegetables)
- Dental services for pregnant adult members
- Non-emergency medical transportation (NEMT)
- Lodging and food coverage (for out of area NEMT travel)
- Sports and camp physicals
- Enhanced eye wear frames
- 24-hour nurse line
Questions about Claims
If you have questions about claims status or how to file a claim, including how to complete claims forms, please contact the Customer Care Center at 888-292-4487.
Pregnancy Notification Report and Newborn Enrollment Notification Report
Notification of Pregnancy Report can be completed by the Member's PCP or OB/GYN physician. The notification of pregnancy form enrolls the expectant mother in the Future Moms program. Enrollment in Future Moms programs is one of the criteria for eligibility for the free infant car seat. Providers may also use the Notification of Pregnancy form as a way to notify BCBSTX of pregnant women who smoke. The Notification of Pregnancy form is located at http://bcbstx.com/provider/pdf/notice_preg.pdf. Fax the completed form to 800-551-2410.
Newborn deliveries require notification. The Newborn Enrollment Notification form can be completed by the obstetrics physician or the pediatrician. The form is located at http://bcbstx.com/provider/pdf/newborn_report.pdf.
Link to BCBSTX Medicaid Website
On this website, you will find links to the Provider Manual, Quick Reference Guide, Services Requiring Prior Authorization, webinars/trainings and other useful information.
Provider Customer Service: 888-292-4487, 7 a.m. to 6 p.m. CT, Monday through Friday
For general questions and concerns:
Jamye Rushing, email@example.com, 512-349-4876; Fax: 512-349-4848
Network Provider Representatives
Juanita Hill, firstname.lastname@example.org, 512-349-4896
Burnet, Williamson, Blanco, Lampasas, Llano, San Saba
Shelby Robinson, email@example.com, 512-349-4897
Lee, Austin County, Bell, Burleson, Milam, Washington
Britton Thibodeaux, firstname.lastname@example.org, 512-349-4898
Bastrop, Caldwell, Fayette, Hays, Colorado, Comal, Gonzales, Guadalupe, Lavaca
Dee Culver, email@example.com, 512-349-4899
Clinical Outreach & Education, Quality/Compliance
Kathy Clark, firstname.lastname@example.org, 512-349-4480
Senior Outreach Specialist/Member Advocate
Sonia Saenz, email@example.com, 512-349-4883
If Sonia is not available, contact Lupe Yanez, firstname.lastname@example.org, 512-349-4887