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Blue Review - Blue Cross and Blue Shield of Texas

January 25, 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.

Upcoming Webinar
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 juanita_hill@bcbstx.com.  Deadline to RSVP is noon, Tuesday, Jan. 30, 2013.
  • Webinar
    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:
  • 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.
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.

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.

Administrative Issues Contact Information
Submit paper claims to:
Blue Cross and Blue Shield of Texas
Attn: Claims
P.O. Box 684787
Austin, TX 78768 - 4787

Provider Complaints
Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
P.O. Box 684249
Austin, TX 78768 - 4787

Provider Appeals - Submit an appeal in writing using the Provider Dispute Resolution Form. Submit within 120 calendar days from receipt of the Remittance Advice (RA) or notice of action letter. The Provider Dispute Resolution Form is located at: http://bcbstx.com/provider/pdf/provider_dispute.pdf.
Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
P.O. Box 684249
Austin, TX 78768

External Review- The provider may request an external review from a non-network provider of the same or related specialty.
Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
P.O. Box 684249 Austin, TX 78768

Check the News & Updates section for the latest information relating to the BCBSTX Medicaid (STAR) and CHIP Program: http://bcbstx.com/provider/network/medicaid.html. This section is located on the BCBSTX provider website on the left hand side of the page.

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
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

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


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 • January 25, 2013 • www.bcbstx.com