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Blue Review - Blue Cross and Blue Shield of Texas

March 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.

Primary Care Providers to Receive Affordable Care Act Rate Increase
To qualify for the Affordable Care Act of 2010 (ACA) rate increase for primary care services, a physician must have a specialty designated of general internal medicine, family practice or pediatrics and must attest to one of the following:
  • The provider has a certification recognized by the American Board of Medical Specialties (ABMS), American Board of Physician Services (AMPS), or American Osteopathic Association (AOA) and meets the requirements as required by federal and state regulation to receive payment.
  • The provider does not have a certification recognized by the ABMS, ABPS, or AOA, but at least 60 percent of the provider's Medicaid billings for the previous calendar year (or for the previous calendar month if the provider has been enrolled in Medicaid for less than one year) were for the evaluation and management (E/M) and vaccine administration procedure codes as published in the final federal and state regulations and the provider meets the requirement to receive payment.
Note:  New providers with no history of Medicaid billings can attest that 60 percent of their Medicaid billing will be for primary care services.

Providers can attest using the Texas Medicaid Attestation for ACA Primary Care Rate Increases form.

The form must be completed by individual providers. The form must be completed, signed and returned by fax to (512) 302-5068, or by mail to:
Texas Medicaid & Healthcare Partnership
P.O. Box 200795
Austin, TX 78720-0795

Providers will not immediately see the increased payment on their Remittance and Status (R&S) reports. The increased rates will be applied retroactively. The state is working with the Centers for Medicare & Medicaid Services (CMS) to get federal approval for the state's plan to increase primary care rates. Health & Human Services Commission (HHSC) will continue to keep providers informed of the process and timeline as information becomes available.

Non-physician Practitioners
Non-physician practitioners who are under the supervision of a provider who has self-attested, are not required to submit a separate provider attestation form. Increased payment may be available to the supervising physician when the following conditions are met:
  • The non-physician practitioner renders services under the personal supervision of a provider who has self-attested to meeting the requirements.
  • Services are billed under the qualifying provider's provider identification number.
Click here for ACA Frequently Asked Question.

For more information on form completion and ACA rate increase, call TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.

HEDIS (Healthcare Effectiveness Data and Information Set) Training and Consultation for Office Staff

BCBSTX provides assistance for medical office staff training in HEDIS activities. Physicians and other professional providers can request a consultation by calling a Community Resource Coordinator at 800-618-3084. Training and consultation includes:
  • Information about the year's selected HEDIS measures
  • How data for those measures will be collected
  • Codes associated with each measure for administrative data
  • Tips for smooth coordination of medical record data collection

Prior Authorization and Documentation Requirements for Comprehensive Outpatient Rehabilitation Facilities (CORFs) and Outpatient Rehabilitation Facilities (ORFs)
A CNM, CNS, nurse practitioner, or physician assistant may sign all documentation related to the provision of therapy services on behalf of the client’s physician when the physician delegates this authority. This applies to occupational therapy, physical therapy and speech therapy.

Adding and Removing Providers

Has your office added a new provider? Has a previous physician left the group? Notify BCBSTX Medicaid (STAR) and CHIP of provider changes within your office. Contact your BCBSTX Medicaid Network Provider Representative. We provide contact information at the bottom of the newsletter, or call 512-349-4876. 

Migrant Farmworkers Training

BCBSTX would like to thank all the participants who attended the Migrant Farmworkers training on March 14, 2013. BCBSTX would also like to congratulate Maria Rangel of CommuniCare who was the raffle winner.

Questions about Claims

ac 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 22, 2013 • www.bcbstx.com