|January 18, 2013 |
For Travis Service-Area Medicaid (STAR) & 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.
Jan. 31, 2013 - Texas Health Steps Training and Luncheon
Lunch will be provided for Live Seminar attendees; all attendees will have the opportunity to play games and win prizes.
You can attend this event in two ways:
- Live Seminar at: BCBSTX Medicaid (STAR) and CHIP Medicaid Office
9442 Capital of Texas Hwy,
Suite 500, Arboretum Plaza II
Austin, TX 78759-6839
Date: Jan. 31, 2013
Time: Noon – 2 p.m.
RSVP: Please RSVP by calling 512-349-4896 or email firstname.lastname@example.org. Deadline to RSVP is noon, Tuesday, Jan. 30, 2013.
Date: Jan. 31, 2013
Time: Noon – 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
Click on the “Join Meeting” button.
CHIP and CHIP Perinatal Immunization Requirements
CHIP and CHIP Perinatal providers are expected to follow these immunization-related requirements regarding the vaccine benefit and claims procedures:
Please note: Providers need to indicate the vaccine administration AND the vaccine itself on the claim form. Providers should understand that they will not be reimbursed for the vaccine, but it must appear on the claim. Providers are also reminded of the importance of entering the immunization into ImmTrac.
- Providers are expected to follow the immunization Standard Requirements set forth in Chapter 161, Health and Safety Code, relating to Texas Immunization Registry (ImmTrac), including parental consent on the Vaccine Information Statements.
- Providers are expected to follow the standards in the Advisory Committee on Immunization Practices (ACIP) Immunization Schedule - CHIP providers need to follow the AAP Periodicity Schedule for CHIP Members.
- If enrolled as a Texas Vaccines for Children )TVFC) provider, a CHIP provider serving CHIP-enrolled patients ages 18 and under can order and utilize TVFC immunization doses at no charge to the provider. The vaccine supply is provided by the Department of State Health Services, and the administration of the vaccine should be billed to the MCO.
For information on TVFC enrollment and ordering supplies, go to: https://www.dshs.state.tx.us/immunize/toolkit/kit1.shtm, or call the Immunization Branch at 512-776-3711; TVFC Provider Enrollment Fax: 512-776-7743. Below are Frequently Asked Questions regarding vaccines for CHIP perinatal clients (Mother/Perinate).
1. Are vaccines for the mother/Perinate (such as TDAP and flu) a covered benefit under CHIP Perinatal?
Yes, vaccines (such as TDAP and flu) are covered benefits of CHIP Perinatal.
2. Are vaccine costs built into the CHIP Perinatal premium?
Yes, cost for the vaccine serum and injection procedure are built into the CHIP Perinatal premium. CHIP Perinate providers should file a claim with the client's CHIP Perinatal health plan in order to receive reimbursement for the vaccine and injection.
3. Are CHIP Perinatal members prohibited from receiving vaccines from Adult Safety Net (ASN) or Texas Vaccine for Children (TVFC) because they should be receiving vaccines through their CHIP Perinatal Plan?
CHIP Perinatal members (above age 18) are prohibited from receiving vaccines from ASN and TVFC. CHIP Perinatal clients are considered to have health insurance coverage, and therefore are not eligible for the ASN. Likewise, CHIP perinatal clients over 18 do not meet the age requirements for TVFC.
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.
- 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.
Claim Filing With the Wrong Plan
If you file a claim with the wrong insurance carrier and provide documentation verifying the initial timely claims filing within 95 days of the date of the other carrier's denial letter or RA form, BCBSTX processes your claim without denying it for failure to file within filing time limits.
Eligibility Fax Back
Call BCBSTX Customer Care Interactive Voice Response (IVR) automated telephone response system at 888-292-4487. The IVR accepts either your billing National Provider Identifier (NPI) or your Federal Tax Identification Number (TPI) for provider identification. Should the system not accept your billing NPI or Federal TPI, your call will be routed to a Customer Care Representative.
Availity Eligibility and Benefits Guide
The Availity Eligibility and Benefits Guide is a reference tool to aid providers who use Availity to verify benefits and eligibility for Medicaid (STAR) and CHIP members. This Availity guide serves as a crosswalk for the search terms for other BCBSTX members and the search terms for Blue Cross and Blue Shield Medicaid (STAR) and CHIP members. The form is located on our website at bcbstx.com. To access the form click here: http://bcbstx-uat.fyiblue.com/pdf/availity_med_tip_sheet.pdf.
Registration with Availity is required to verify eligibility and benefits.
Value Added Services
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 888-292-4480.
Value Added Services:
For more information on any of these Value Added Services, please review our Value Added Services Training PowerPoint located at http://bcbstx.com/provider/network/medicaid.html, under Medicaid (STAR) and CHIP Provider Training.
- 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)
- 24-Hour Nurse Line
2012-2013 RSV (Respiratory Syncytial Virus) Season
Prior approvals for Synagis were available through BCBSTX beginning Sept. 15, 2012. The PA form can be found at bcbstx.com/provider/network/medicaid.html.
The start of the 2012-2013 respiratory syncytial virus (RSV) season varies based on a patient’s county of residence, with most areas in Texas beginning Oct. 1, 2012, and ending March 15, 2013. To learn more about the Synagis county schedule, visit www.txvendordrug.com.
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, 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
For Member Outreach inquiries, BCBSTX Medicaid (STAR) and CHIP members may contact
Sonia Saenz, Senior Outreach Specialist/Member Advocate, email@example.com, 512-349-4883
Senior Outreach Specialist/Member Advocate
Sonia Saenz, firstname.lastname@example.org, 512-349-4883
If unable to reach Sonia, please contact Lupe Yanez at email@example.com, 512-349-4887