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.

"A Message from the Texas Health and Human Services Commission (HHSC)"
Texas Women’s Health Program Offers Continuity of Care
The Texas Women’s Health Program is looking for doctors – physicians with a specialty in family practice, gynecology, OB/GYN, internal medicine, or pediatrics – who want to help low-income women take control of their futures. You can make a dramatic difference in the lives of women who need the expertise and health services you offer.

“The comments we received from physician groups helped shape the development of the new state program,” said Texas Health and Human Services Executive Commissioner Kyle Janek, M.D. “I encourage physicians to join the Texas Women’s Health Program. It’s a great way to provide excellent services to low-income Texas women and to your communities.”

The women who benefit from this fee-for-service, state-funded program are between 18 and 44 years old. They don’t qualify for Medicaid or have health insurance. The Texas Women’s Health Program provides them with an annual family planning exam, health screens for things like diabetes and breast and cervical cancer, treatment for certain sexually transmitted diseases and family planning services such as birth control.

The program offers an opportunity for providers to continue caring for patients whose Medicaid coverage expires after giving birth. Continuity of care is an important aspect of the program for participating doctors, as well as women who want consistency in their family planning and health care.

Any Medicaid provider that offers services covered by the program and complies with the new program rules can enroll as a Texas Women’s Health Program provider.

Learn more about enrolling in Medicaid or certifying as a Texas Women’s Health Program provider at www.tmph.com. Click the providers link:

To enroll as a Medicaid provider, click Enroll Today in the web page banner. To certify as a Women’s Health Program provider, click the Texas WHP tab under the banner.

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 should 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.

Texas Medicaid & Healthcare Partnership Online Fee Lookup (OFL)
Changes to the Online Fee Lookup are now available, including changes to the static fee schedule. More information about these items is available on the TMHP website, www.tmhp.com.

For more information, contact TMHP at 800-925-9126.

Texas Medicaid Provider Procedures Manual to be Updated Monthly Instead of Annually
Effective Aug. 15, 2012, the Texas Medicaid Provider Procedures Manual is updated monthly instead of annually. The updated chapters will be published around the 15th of each month. The manual is available at www.tmhp.com, on the Texas Medicaid Provider Procedures Manual web page, which can be accessed by clicking the Reference Material button on any web page in the Texas Medicaid provider section. Each month, the manual will be updated with policy and procedure changes that were implemented at the beginning of the previous month.

Monthly updates to the manual will eliminate the need for the bimonthly Texas Medicaid Bulletin, which will be discontinued. The September/October 2012 Texas Medicaid Bulletin, No. 243, was the final edition to be published. Previous editions of the bulletin will continue to be available in the archives of the TMHP website.

There will be no change in the way website articles and banner messages are published. Website articles will continue to be published as needed, and banner messages will continue to be included on the providers’ weekly Remittance and Status (R&S) Reports.

The most recent edition of the provider manual will be available on the Texas Medicaid Provider Procedures Manual web page. Links at the bottom of that web page will take providers to the following:

Release Notes – Release notes are arranged by date (newest first) and include the name of the files that were updated and the revision date. Clicking Details  next to a revision date will display comments about the changes that were made to each file and links to relevant website articles, if applicable. The release notes will describe the nature of the changes, with links to relevant website articles, if applicable. Change History – The change history page will allow providers to see how individual chapters change over time, which will make it easier to research past changes to the manual.

Providers will no longer have to wait for an entire year before updates to the TMHP provider manual are published. For more information, call the TMHP Contact Center at 800-925-9126.

Recent Website Additions

Member Outreach Request Form – This form is used to request a Community Resource Coordinator contact a BCBSTX Medicaid (STAR) or CHIP member. The Community Resource Coordinator is able to assist the member with Health Education Classes, New Member Benefits, No-Show for appointments, Community reasons and noncompliance. The form is located on the BCBSTX website, bcbstx.com/provider/network/medicaid.html, under BCBSTX Medicaid (STAR) and CHIP Forms. How to Fill Out a CMS-1500 Claim Form – Providers may have to submit paper claims to the program. This form provides claims completion instructions to help ensure providers are submitting clean claims. This form is located on the BCBSTX website, bcbstx.com/provider/network/medicaid.html, under BCBSTX Medicaid (STAR) and CHIP Claims. Medicaid (STAR) and CHIP Texas Health Steps Information – This tab provides information related specifically to TH Steps. This tab includes TH Steps claims submission instructions, educational forms, links to other valuable information and more. The Medicaid (STAR) and CHIP Texas Health Steps tab is located on the BCBSTX website at bcbstx.com/provider/network/medicaid.html

News & Updates Additions Located on the BCBSTX Provider Website

BCBSTX Medicaid (STAR) and CHIP Implements New or Revised Medical Policies Bulletin How To Submit Claims for Physician Administered Drugs Bulletin

BCBSTX Medicaid (STAR) and CHIP Provider Manual Update
The updated BCBSTX Medicaid (STAR) and CHIP provider manual will available on the BCBSTX website, bcbstx.com/provider/network/medicaid.html, January 2013.

Medicaid (STAR) and CHIP Newsletter Archive
BCBSTX began archiving its weekly Medicaid (STAR) and CHIP newsletter on the Medicaid page of our provider website, Oct. 5, 2012. The archived newsletters will be available on the website for three months. Click on the following link and then click the Medicaid (STAR) and CHIP Newsletter navigation link under News & Updates.
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