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Blue Review - Blue Cross and Blue Shield of Texas

March 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.

Now Available - March 2013 BCBSTX Medicaid (STAR) and CHIP Provider Manual
The Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR) and CHIP Provider Manual is now available on the BCBSTX provider website, bcbstx.com/provider/network/medicaid.html. The provider manual includes program changes/updates and contains valuable resource information. We encourage providers to utilize the provider manual to find answers to their questions. If you do not know the password, please contact the Professional Provider Network Office at 512-349-4876.


Upcoming Trainings

Children of Migrant Farmworkers Training
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 that will 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 Checkups
  • And more....
Guest Presenter: Sylvia Partida, National Center for Farmworker Health

This event will take place March 14, 2013, noon to 2 p.m. Lunch will be provided.

Location:
Marie Callender's
9503 Research Blvd., Suite 400
Austin, TX 78759

RSVP: Please RSVP to Juanita Hill by noon March 13, 2013, by emailing juanita_hill@bcbstx.com or by calling 512-349-4896.


BCBSTX Medicaid (STAR) and CHIP Provider Availity Workshops

Please join Blue Cross and Blue Shield of Texas (BCBSTX ) and Availity®’ for an educational workshop on the tools and features of Availity. The workshop will be held at:
Blue Cross and Blue Shield of Texas
9442 Capital of Texas Highway North
Suite 500, Arboretum Plaza II
Austin, Texas 78759

Topics covered will include:
  • Verification of Medicaid member eligibility
  • Verification of Medicaid member benefits
  • Checking the status of BCBSTX Medicaid claims
  • And more.....
Three training sections will be offered. Training will take place on Thursday, March 21, 2013, at the times listed below:
  • 9 a.m. to 10 a.m.
  • 11 a.m. to Noon
  • 1 p.m. to 2 p.m.

Hands-on training will be provided after each workshop. Providers are encouraged to bring their Availity user ID and password and examples (claims, eligibility and benefits).

Light snacks and drinks will be provided at each session.

RSVP: Please RSVP by to Juanita Hill by noon March 20, 2013, by emailing juanita_hill@bcbstx.com or by calling 512-349-4896.


Balance Billing

Providers are prohibited from balance billing members for covered services. Providers are prohibited from billing or collecting any amount from a Medicaid (STAR) member for health care services provided. Federal and state laws provide severe penalties for any provider who attempts to bill or collect any payment from a Medicaid recipient for a covered service. Prohibition of balance billing applies to the member or the members' guardian.


Second Opinions

Most second opinions regarding medically necessary covered services are offered at no cost to members. Some CHIP members may have a copayment.

A second opinion must be given by an appropriately qualified health care professional. When the request is regarding care from a specialist, the second opinion must come from a provider of the same specialty. This specialist must be within BCBSTX’s network and may be selected by the member.

For cases in which there is no network provider who meets the specific qualification, we may authorize a second opinion by a qualified provider outside of the network, upon request by the member or provider.


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.

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 • March 8, 2013 • www.bcbstx.com