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Blue Review - Blue Cross and Blue Shield of Texas

February 22, 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.

Children of Migrant Farmworkers Training and Luncheon
Join BCBSTX Medicaid (STAR) and CHIP provider network representatives for an in-depth look at the children of migrant farmworkers population. Some of the topics to be covered include:
  • How to identify children of migrant farmworkers
  • Children of migrant farmworkers demographics, occupational risks, and the impact on health care delivery
  • Children of migrant farmworkers and Texas Health Steps exams
  • And more....
This event will take place February 28, 2013, Noon – 2 p.m.

Lunch will be provided for Live Seminar attendees.

You can attend these events in two ways:

1. Live Seminar at:

BCBSTX Medicaid (STAR) and CHIP Medicaid Office
9442 Capital of Texas Hwy,
Suite 500, Arboretum Plaza II
Austin, TX 78759-6839

Feb. 28, 2013   
Time: Noon to 2 p.m.
RSVP: Please RSVP by calling 512-349-4896 or email juanita_hill@bcbstx.com. The deadline to RSVP is noon, Feb. 27, 2013.

2.  Webinar
  Date: Feb. 28, 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

Services Available to BCBSTX Medicaid (STAR) and CHIP Members

BCBSTX resolves complaints and appeals related to any aspect of service provided by it or any subcontractor providing services on behalf of the plan.  

Customer service can assist members with their rights and responsibilities and the filing of complaints and appeals.

Visit our website at bcbstx.com/provider/pdf/mem_complaints.pdf for more detailed information regarding appeals, how to file a complaint, resolution of STAR and CHIP member complaints, timelines, resolution and more.

Billing Members for Services Not Medically Necessary or Not Covered

Providers may bill a BCBSTX member for a service that is not medically necessary or not a covered benefit if all of the following conditions are met:
  • The patient requests a specific service or item that, in your or BCBSTX’s opinion, may not be reasonable and medically necessary.
  • You must obtain and keep a written acknowledgment statement (see the sample Member Acknowledgment Statement) form at bcbstx.com/provider/network/medicaid.html verifying that you notified the BCBSTX member of financial responsibility for services rendered.
  • This acknowledgement must be signed and dated by the member. If the services the member requested are determined not to be medically necessary by BCBSTX, then the signed acknowledgment statement must indicate that the member has been notified of the responsibility to pay these services.

Private Pay Form Agreement
You may bill a member without a signed Member Acknowledgement Statement form if:
  • The service received is not a benefit of the Medicaid program. You must inform the member that the service in question is not a benefit under BCBSTX and notify the member of financial responsibility.
  • You accept the member as a private-pay patient. You must advise members that they are accepted as private-pay patients at the time of service and will be responsible for paying for all services received. In this situation, BCBSTX strongly encourages that notification be in writing with the member’s signature and date so that there is no question of whether the member has been properly notified of the private-pay status (refer to the sample Private Pay Form Agreement on our website).

Website Resources
  • Member Outreach Request Form – This form is used to request that 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 provider website at 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. This form provides claims completion instructions to help ensure providers are submitting clean claims. This form is located on the BCBSTX provider website at 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 Texas Health Steps. This tab includes Texas Health 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 provider website at bcbstx.com/provider/network/medicaid.html.

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.

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 22, 2013 • www.bcbstx.com