| November 30, 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.
Texas Vaccines for Children (TFVC)
Medicaid (STAR) and CHIP Program providers who administer vaccines to children 0 to18 years old may enroll in the Texas Vaccines for Children (TVFC) program. Providers who administer vaccines to children 0 to 18 must be enrolled in Texas Health Steps, formerly known as the Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) program. Contact Texas Vaccines for Children at 800-252-9152.
Reimbursement for Texas Vaccine for Children (TVFC)
BCBSTX will only reimburse the administration fee for any vaccine available through the VFC program. The only time a provider will be paid for use of private vaccine stock is when TVFC posts a message on its website that no stock is currently available. In that case, the Medicaid claim should include modifier U1, which indicates private stock. Providers enrolled in TVFC must use TVFC as the source of vaccines for eligible patients when TVFC has the vaccine available for shipment. Billing for Immunizations Provided by the Texas Vaccines for Children Program
When billing immunizations provided to you by the Texas Vaccines for Children (TVFC) program, you must use the appropriate CPT code on one line of Box 24D of the CMS-1500 form. On another line of Box 24D, use the appropriate administration procedure code (90471 through 90474). In Box 23 of the CMS-1500, insert the PCP name. Billing for Immunizations NOT Covered by the Texas Vaccines for Children Program (TVFC)
When billing immunizations not covered by the TVFC program, use the appropriate CPT code on one line of Box 24D and the appropriate administration procedure code on another line of Box 24D. The SL modifier is not required.
HPV (Human Papilloma Virus) Vaccine
The HPV vaccine will be considered for reimbursement to providers for patient’s ages 9 to 18 when the vaccine is not available through the Texas Vaccines for Children (TVFC) program. Providers should submit claims with the U1 modifier.
When billed without a modifier, the procedure code is informational only, allowing providers to be paid the administration fee. In addition, the HPV vaccine will be payable to providers who administer the HPV vaccine for patients ages 19 to 20. Provider enrolled in TVFC must use TVFC as the source of the HPV vaccine for eligible patients when TVFC has HPV available for shipment.
Pharmacy with Durable Medical Equipment Billing Changes Effective Nov. 12, 2012
On Nov. 12, 2012, the State of Texas updated 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
Enhancements to ClaimsXten Code Auditing Tool
BCBSTX will implement new rules to the ClaimsXten code auditing tool into our claim processing system beginning Dec. 8, 2012. The tool can automate claim review, code auditing and payment administration, which we believe results in improved performance of overall claims management.
All BCBSTX Medicaid (STAR) and CHIP providers were mailed a notification letter regarding the changes during the week of Sept. 10, 2012. The letter is also located on the BCBSTX provider website at http://bcbstx.com/provider/network/medicaid.html under News & Updates. The new ClaimsXten processing grid is also located on our provider website under the Medicaid (STAR) and CHIP Claims tab, subheading McKesson ClaimsXten Rules: http://bcbstx.com/pdf/cxten_rules.pdf.
Quarterly Medicaid (STAR) and CHIP Specialty Drug List: Effective Sept. 13, 2012
The current quarterly Medicaid (STAR) and CHIP specialty drug list became effective Sept. 13, 2012. The list is posted on the Vendor Drug Program (VDP) webpage at http://www.txvendordrug.com/formulary/specialty-drugs.shtml.
The following drugs have been added and no drugs have been deleted from the previous list. The updated list will be posted to the VDP website and will include a running list of the changes made each quarter. Generic Name | Brand Name | Vismodegib | Erivedge | Axitinib | Inlyta | Doxorubicin HCL | Doxil | Immune Globulin | Gammaked | Ruxolitinib | Jakafi | Future quarterly updates will become effective on the following dates:
- Dec. 1, 2012
- March 1, 2013
- April 1, 2013
- Sept. 1, 2013
| Archiving Newsletters
BCBSTX began archiving the weekly Medicaid (STAR) and CHIP newsletters on our provider website. The first archived newsletter is Oct. 5, 2012. The newsletters will be available on the website for three months. The newsletters will be located on the left hand side of the website under News & Updates.
http://bcbstx.com/provider/network/medicaid.html
News and Updates Section Added to Provider Website
We have added a new feature to our provider website titled: News & Updates. This new section is located on our provider website on the left hand side of the page. Check the News & Updates section for the latest information relating to the BCBSTX Medicaid (STAR) and CHIP Program.
http://bcbstx.com/provider/network/medicaid.html
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.
http://bcbstx.com/provider/network/medicaid.html
Contact Us
Provider Customer Service: 888-292-4487, 7 a.m. to 6 p.m. CT, Monday through Friday
For general questions and concerns:
Jamye Rushing, jamye_rushing@bcbstx.com, 512-349-4876; Fax: 512-349-4848 Network Provider Representatives
Juanita Hill, juanita_hill@bcbstx.com, 512-349-4896
Burnet, Williamson, Blanco, Lampasas, Llano, San Saba Shelby Robinson, shelby_robinson@bcbstx.com, 512-349-4897
Lee, Austin County, Bell, Burleson, Milam, Washington Britton Thibodeaux, britton_thibodeaux@bcbstx.com, 512-349-4898
Bastrop, Caldwell, Fayette, Hays, Colorado, Comal, Gonzales, Guadalupe, Lavaca Dee Culver, deanna_culver@bcbstx.com, 512-349-4899
Travis Clinical Outreach & Education, Quality/Compliance
Kathy Clark, kathy.clark@wellpoint.com, 512-349-4480 For Member Outreach inquiries, BCBSTX Medicaid (STAR) and CHIP members may contact
Sonia Saenz, Senior Outreach Specialist/Member Advocate, sonia.saenz@wellpoint.com, 512-349-4883 Senior Outreach Specialist/Member Advocate
Sonia Saenz, sonia.saenz@wellpoint.com, 512-349-4883
If unable to reach Sonia, please contact Lupe Yanez at guadalupe.yanez@wellpoint.com, 512-349-4887 | 