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Blue Review - Blue Cross and Blue Shield of Texas

March 15, 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.

CHIP Provider Responsibility
Providers are responsible for collecting any applicable copayments or deductibles at the time of service, in accordance with Children’s Health Insurance Program (CHIP) cost-sharing limitations. The CHIP member’s copayment is listed on their ID card.

Families that meet the enrollment period cost-sharing limit requirement must report it to Maximus, the Texas Health and Human Service Commission (HHSC) Administrative Services Contractor. Upon notification from Maximus that the cost-sharing limit has been reached, BCBSTX will issue the CHIP member a new member ID card within five days, showing that the member’s cost-sharing limit has been met. No copayments may be collected from these CHIP members for the balance of their term of coverage.

Immunizations, Well-Child, Well-Baby
No copayments apply, at any income level, to well-child or well-baby visits or immunizations, except for costs associated with unauthorized, non-emergency services provided by out-of-network providers and for non-covered services.

Native American Tribes and CHIP Perinate
Federal law prohibits charging copayments, deductibles or out-of-pocket costs to CHIP and CHIP Perinate members of Native American Tribes. When a member is identified as a member of a Native American Tribe, the member will be issued a member ID card showing the member has no cost-sharing obligations. CHIP Perinate members are also exempt from cost-sharing and are not required to pay co-pays.

Parental Accompaniment Requirement Rule

The Texas Administrative Code (TAC) requires a Medicaid client who is 14 years of age or younger to be accompanied by a parent, guardian or another adult who has been authorized by the parent or guardian to make medical decisions when a service is provided or furnished during a Texas Health Steps (THSteps) visit or screening, or when a benefit or service is provided through the Medical Transportation Program.

The adult who is authorized to accompany a client cannot be the provider of a service for which reimbursement is sought or someone employed by or affiliated with a provider of a service for which reimbursement is sought.

Providers who serve as authorized adults in violation of the rule or who allow their employees or affiliates to serve as authorized adults will not be reimbursed for the services provided to the client. As a reminder, THSteps providers are also expected to comply with the standard which requires providers to assure that a parent, guardian or authorized adult who is accompanying a client who is 14 years of age or younger waits for the client while the treatment takes place.

An individual transportation provider (ITP) can be designated as the authorized adult as long as the ITP is not the provider of the Texas Health Steps service or an employee of or affiliated with the Texas Health Steps provider.

The rule went into effect Jan. 1, 2013, and will be enforced for dates of service on or after March 1, 2013.

Texas Health Steps Laboratory Requirements

For Medicaid members, Texas Health Steps requires providers to use the DSHS Laboratory Services for specimens obtained as part of a Texas Health Steps medical checkup, including Texas Health Steps newborn screens, blood lead testing, hemoglobin electrophoresis and total hemoglobin tests that are processed at the Austin Laboratory; and Pap Smear, Gonorrhea and Chlamydia screening processed at the Women’s Health Laboratories in San Antonio.

Providers may submit specimens for glucose, cholesterol, HDL, lipid profile, HIV and RPR to the DSHS Laboratory or to a laboratory of the provider’s choice. Hematocrit may be performed at the provider’s clinic if the provider needs an immediate result for anemia screening. Providers should refer to the Texas Health Steps Online Provider Training Modules referencing specimen collection on the DSHS website and the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook for the most current information and any updates.

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.


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.

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 • March 15, 2013 • www.bcbstx.com