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Blue Review - Blue Cross and Blue Shield of Texas

February 8, 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.

New Billing Requirements for CHIP Perinate Postpartum Visits
CHIP Perinate Mothers are entitled to a maximum of two postpartum visits. CHIP Perinate Mother’s eligibility terms at the end of the month that the baby was born. If a provider calls to check benefits after the month of the baby’s birth, they will be advised the CHIP Perinate Mother is not eligible.

CHIP Perinate Mothers may receive their postpartum visits after their eligibility ends (at the end of the month of the baby’s birth). To be reimbursed for the postpartum visits, providers must bill using the CPT delivery codes that include postpartum care.  See below for a list of codes. The reimbursement amount for the below procedure codes includes both postpartum care visits.

If the provider bills any other code and the date of service is after the CHIP Perinate Mother’s eligibility has termed, the provider will not receive payment for the postpartum care. 

If the claim were submitted with the incorrect code, you may re-submit the original delivery claim with the correct code within the 120-day appeal deadline. 

If you have any questions, contact the Customer Care Center at 888-292-4487 or your Provider Network Representative at 512-349-4876.

CPT Delivery Code

Description

59410

Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum

59515

Cesarean delivery only; including postpartum care

59614

Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care

59622

Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care

For More Information
If you have questions about proper postpartum billing or CHIP Perinate member eligibility for postpartum care, please contact the Customer care Center at 888-292-4487 or your Provider Network Representative at 512-349-4876.

*These changes only apply to CHIP Perinate Postpartum visits. For Medicaid (STAR) postpartum billing requirements refer to the BCBSTX Medicaid (STAR) and CHIP Provider Manual.


Upcoming Training Events

Feb. 19, 2013 - OB/GYN Claims and Billing, Noon to 2 p.m.
Feb. 28, 2013 - Children of Migrant Farmworkers Training and Luncheon, Noon to 2 p.m.

You can attend these events in two ways:

Click on the “Join Meeting” button.


Updating Demographics
Have you moved into a new office recently? Changed your telephone number? Do you have patients with missed appointments or arriving late for appointments?

If you answered ‘yes’ to any of these questions, please confirm your address and phone number located in our Provider Finder.

If a change is necessary, send the correct information via email or fax to BCBSTX Medicaid at the contact information listed at the end of the newsletter. Also update Texas Medicaid and Healthcare Partnership (TMHP) via the Provider Information Change form available at http://www.tmhp.com/Provider_Forms/Provider%20Enrollment/Provider-Information-Change-Form.pdf and the Health and Human Services Commission's administrative services contractor.

Thank you for taking the time to verify your information and for the service you provide to BCBSTX Medicaid (STAR) & CHIP members.


BCBSTX Medicaid (STAR) and CHIP Provider Manual Updates

The updated BCBSTX Medicaid (STAR) and CHIP Provider Manual will be available February 2013 on the BCBSTX provider website at http://bcbstx.com/provider/network/medicaid.html.


Archiving Bulletins

Providers can locate archives of the BCBSTX Medicaid (STAR) and CHIP weekly newsletter on our website. The newsleters will be available on the website for three months from the issue date. The newsletter is located on the left-hand side of the website, under Medicaid (STAR) and CHIP Newsletter.
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 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
Blanco, Burnet, Lampasas, Llano, Williamson (Georgetown)

Shelby Robinson, shelby_robinson@bcbstx.com, 512-349-4897
Austin County, Bell, Burleson, Lee, Milam, San Saba, Washington, Williamson (Round Rock)

Britton Thibodeaux, britton_thibodeaux@bcbstx.com, 512-349-4898
Bastrop, Caldwell, Colorado, Comal, Fayette, Gonzales, Guadalupe, Hays, Lavaca

Dee Culver, deanna_culver@bcbstx.com, 512-349-4899
Travis, Williamson (except Georgetown, Round Rock)

Clinical Outreach & Education, Quality/Compliance
Kathy Clark, kathy.clark@wellpoint.com, 512-349-4880

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

 


BCBSTX makes no endorsements, representations, or warranties about any products or services offered by
independent, third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or
services offered by them. If you have any questions about the products or services mentioned in this newsletter,
contact the vendor directly.

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an Independent Licensee of the Blue Cross and Blue Shield Association.

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Blue Review Medicaid (STAR) & CHIP Update • February 8, 2013 • www.bcbstx.com