|November 2, 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.
The following prenatal vitamins article is a correction from the article titled PreNatal Vitamins in the Oct. 26, 2012, newsletter edition.
Prenatal vitamins are covered under the pharmacy benefit for STAR and CHIP/CHIP Perinate with a written prescription from a physician. Only those prenatal vitamins found on the Texas Vendor Drug Program Formulary are included in this benefit. Over-the-counter drugs are covered for STAR members if they obtain a prescription from their physician for a formulary drug. Over-the-counter medications are not a covered benefit for CHIP or CHIP Perinate members.
Nov. 6, 2012, Noon to 2 p.m.: Provider Orientation – Comprehensive Overview
If you have ever asked these questions in your office, join BCBSTX Medicaid (STAR) and CHIP Provider Network Representatives for an educational seminar/webinar. There will be games and prizes!
- What is the claims address and timely filing deadline?
- Does BCBSTX Medicaid accept secondary claims submitted electronically?
- What is a “mailback” form?
- What is an acceptable form of proof of timely filing?
Lunch will be provided for live seminar attendees, and all attendees will have the opportunity to play games and win prizes.
You can attend this event in two ways:
|1. Live Seminar at Blue Cross Blue Shield of Texas, 9442 Capital of Texas Hwy N, Suite 500, Arboretum Plaza II, Austin, Texas 78759 |
Date: Nov. 6, 2012
Time: Noon to 2 p.m.
RSVP: Space is limited at the live seminar, so please RSVP to firstname.lastname@example.org or
call 512-349-4896 by Nov. 5, 2012.
Date: Nov. 6, 2012
Time: Noon to 2 p.m.
Dial-In Attendance Information
Step 1: Dial into the conference call at 866-308-0254. The passcode is 2142100850#.
Step 2: Log into the Live Meeting webinar at https://www.livemeeting.com/cc/wellpointinc/join?id=BCBSTPT&role=attend&pw=BCBST+Provider. Click on the “Join Meeting” button.
Pharmacy with DME Billing Changes Effective Nov. 12, 2012
On Nov. 12, 2012, the state of Texas will update the Medicaid formulary to include limited home health supplies (LHHS). This change applies to Medicaid (STAR) only. All CHIP DME providers should continue to submit claims for these supplies on a medical claim form and follow the medical claims submission process as they do now.
Effective Nov. 12, 2012, BCBSTX STAR requires claims for limited home health supplies (certain covered glucose monitors and test strips) to be submitted as a pharmacy claim at an in network Express Scripts network pharmacy. These claims (STAR only) will now be processed as a pharmacy benefit, not a medical benefit. All CHIP DME should continue to be filed as a medical benefit.
Pharmacies that provide DME and DME providers will receive a detailed letter regarding these revised billing requirements. For more information please see the Texas Vendor Drug Program: http://www.txvendordrug.com/formulary/limited-hhs.shtml
Services Available to BCBSTX Medicaid (STAR) and CHIP Members
BCBSTX resolves complaints and appeals related to any aspect of service provided by it or any subcontractor providing services on behalf of the plan.
Customer service can assist members with their rights and responsibilities and the filing of complaints and appeals.
Visit our website at http://bcbstx.com/provider/pdf/mem_complaints.pdf for more detailed information regarding appeals, how to file a complaint, resolution of STAR and CHIP member complaints, timelines, resolution and more.
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.
Referrals to Providers and Laboratories
Only Medicaid attested providers and laboratories are eligible for reimbursement under the Medicaid Program. Providers must ensure referrals are to Medicaid attested providers and Medicaid attested laboratories.
In network labs
BCBSTX Medicaid (STAR) & CHIP is currently contracted with Clinical Pathology Labs and Quest Laboratory. To locate in network labs, visit the Provider Finder at http://public.hcsc.net/providerfinder/medicaid-search.do?corpEntCd=TX1.
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 unable to reach Sonia, please contact Lupe Yanez at firstname.lastname@example.org, 512-349-4887