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.

Primary Care Provider Rate Increase Delayed
Texas will be increasing Medicaid primary care rates, including those for certain physician visits and vaccine administration, as quickly as possible. However, the state did not receive final federal regulations on the rate increase until Nov.1, 2012. This was too late to allow the state to meet the Jan. 1, 2013, implementation date authorized in the Affordable Care Act.

Once the state increases primary care rates, we will make retroactive payments for the increase for providers and services that qualify under the federal regulations. The state is working with the U.S. Centers for Medicare and Medicaid Services to obtain federal approval for the state’s plan to increase primary care rates. We will continue to keep providers informed of the process and timeline.

News and Updates Section Added to BCBSTX Provider Website
We have added a new feature to the BCBSTX provider website titled: News & Updates. This new section can be 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

Electronic Claims Submission
Providers who submit electronic claims have contracted with a vendor, clearinghouse or billing service to submit claims. Providers must follow that entity's instructions. These instructions may differ from BCBSTX Medicaid instructions. The ultimate goal is that the vendor, clearinghouse or billing service submits the claims to BCBSTX Medicaid (STAR) and CHIP with the correct payor identification.

Electronic Claims
BCBSTX cannot be responsible for claims never received. You must work with vendors to help ensure files are successfully submitted to BCBSTX. Failure of a third party to submit a claim to BCBSTX may risk your claim being denied for untimely filing if those claims are not successfully submitted during the filing limit.

After submitting electronics claims, do the following:

Monitor claim status by calling the Customer Care Center at 888-292-4487 or through the Interactive Voice Response (IVR). Watch for (and confirm) plan Batch Status Reports from your vendor/clearinghouse to help ensure your claims have been accepted by BCBSTX. You can correct and resubmit Batch Status Reports and error reports electronically. Correct any errors and resubmit (electronically) immediately to prevent denials due to untimely filing.

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.

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

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