|January 4, 2013 |
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.
Adding and Removing Providers
Has your office added a new provider? Has a provider left the group? Notify BCBSTX Medicaid (STAR) and CHIP of provider changes within your office by calling 512-349-4876 or by fax at 512-349-4848.
Initial Health Assessments
The PCP functions as the “medical home” or “patient advocate” and is responsible for member access to health care. BCBSTX strongly recommends that an initial health assessment (IHA), consisting of a complete history and physical, be conducted within 90 days from the member’s date of enrollment with BCBSTX. Preventive services are to be rendered according to adult and Pediatric Preventive Health Care Guidelines.
Billing Codes for Initial Health Assessments
When billing for preventive services, use these International Classification of Diseases, (ICD, current version) diagnosis codes:
- V20.2 for children (newborn to 18 years of age)
- V70.0 for adults (19 years and older)
Denials for Lack of Prior Authorization Effective Immediately
BCBSTX Medicaid (STAR) and CHIP will deny claims submitted with medical records when no prior authorization was received. Medical records will not be reviewed with the initial claim submission if the provider failed to obtain prior authorization.
This denial will be upheld regardless of correspondence or appeals with the exception of claims submitted for services that were provided on an “emergent” basis. If this exception is stated via the appeal, medical records will be sent for clinical review to determine the medical necessity/emergency. If the service provided is determined to be a medical emergent service, the claim will be allowed. If not, the denial will be upheld.
News & Updates Additions Located on BCBSTX Website
- PCP Rate Increase Bulletin
- Changes for Hospital Claims
Link to BCBSTX Medicaid Website
On this website, you will find links to the Provider Manual, Quick Reference Guide, Services Requiring Prior Authorization 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, firstname.lastname@example.org, 512-349-4876; Fax: 512-349-4848
Network Provider Representatives
Juanita Hill, email@example.com, 512-349-4896
Burnet, Williamson, Blanco, Lampasas, Llano
Shelby Robinson, firstname.lastname@example.org, 512-349-4897
Lee, Austin County, Bell, Burleson, Milam, San Saba, Washington
Britton Thibodeaux, email@example.com, 512-349-4898
Bastrop, Caldwell, Fayette, Hays, Colorado, Comal, Gonzales, Guadalupe, Lavaca
Dee Culver, firstname.lastname@example.org, 512-349-4899
Clinical Outreach & Education, Quality/Compliance
Kathy Clark, email@example.com, 512-349-4480
For Member Outreach inquiries, BCBSTX Medicaid (STAR) and CHIP members may contact
Sonia Saenz, Senior Outreach Specialist/Member Advocate, firstname.lastname@example.org, 512-349-4883
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