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Blue Review - Blue Cross and Blue Shield of Texas

February 1, 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.

Pregnancy Notification Report and Newborn Enrollment Notification Report
Notification of Pregnancy Report may be completed by the Member's PCP or OB/GYN physician. The notification of pregnancy form enrolls the expectant mother in the 'Future Moms' program. Enrollment in the 'Future Moms' Programs is one of the criteria for eligibility for the free infant car seat. Providers may also use the Notification of Pregnancy form as a way to notify BCBSTX of pregnant women who smoke. The Notification of Pregnancy report may be completed online or printed and fax; it can be found on the BCBSTX provider website, bcbstx.com/providers. (http://bcbstx.com/provider/network/medicaid.html

Newborn deliveries require notification. The Newborn Enrollment Notification form may be completed by the Obstetrics physician or the Pediatrician. The form is located at: http://bcbstx.com/provider/pdf/newborn_report.pdf


Value Added Services Spotlight

24-Hour Nurse Line
– This line is available to answer provider questions after hours regarding member eligibility and Primary Care Physician verification.  

Help is available to Medicaid (STAR), CHIP and CHIP Perinate members through a 24-hour, seven-day-a-week toll-free Nurse Line. Nurses are available to provider general information and to speak confidentially with adolescents about health-related issues.  

The 24-Hour Nurse Line also features an audiotape library with more than 300 health related topics. The 24-Hour Nurse Line uses interpreter services to accommodate the needs of non-English-speaking members.

To contact the 24-Hour Nurse Line call 877-351-8392.


Pregnant Teens

Provider Responsibility
Network providers are required to notify BCBSTX Medicaid immediately upon identification of a pregnant CHIP member for Medicaid eligibility determination. A CHIP member who is potentially eligible for Medicaid must apply for Medicaid. A pregnant CHIP member who is determined to be Medicaid-eligible will no longer be eligible for CHIP and will be disenrolled from the program. Medicaid coverage will be coordinated to avoid gaps in health care coverage. 

If BCBSTX remains unaware of a CHIP member's pregnancy until delivery, the delivery will be covered by CHIP.  Eligibility of newborns must be determined for CHIP before enrollment can occur. For newborns determined to be CHIP-eligible, the baby will be covered from the beginning of the month of birth for the period of time specified in the member handbook.

Since Medicaid provides a much more comprehensive scope of services for both the pregnant teen and her newborn, it is in the best interest of the pregnant teen to receive Medicaid coverage as early as possible. For this reason, it is critical that providers notify BCBSTX immediately upon learning about a CHIP member's pregnancy and/or delivery.


BCBSTX Medicaid (STAR) and CHIP Provider Manual Updates

The updated BCBSTX Medicaid (STAR) and CHIP Provider Manual will be available in February on the BCBSTX provider website at http://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
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

 


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.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

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Blue Review Medicaid (STAR) & CHIP Update • February 1, 2013 • www.bcbstx.com