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Blue Review - Blue Cross and Blue Shield of Texas

April 19, 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.

2013 Immunization Schedule Now Available
The recommended Childhood and Adolescent Immunization Schedule for 2013 is now available on www.tmhp.com. The updated immunization schedule can be found in the April 2013 release of the Texas Medicaid Provider Procedures Manual, Children's Services Handbook.

Texas Health Steps Missed Appointments

If a Texas Health Steps (THSteps) member misses an appointment, providers should complete a Missed Appointment form and fax it to the THSteps Special Services Unit - Maximus at 512-533-3867. For more information regarding this form, please call 877-847-8377.

Maximus will then contact the parent or legal guardian to determine what prevented the member from attending the appointment, (e.g., lack of transportation, child care, money for gasoline, etc.).

Here is a link to the THSteps Missed Appointment form.

Referral Process
Primary Care  Physician Referral Process
In-Network referrals: Primary care physicians (PCPs) may refer members to in-network specialists and other professional providers by completing and faxing the Record of Referral to Specialty Care form to the provider to whom the member is being referred.  The Record of Referral to Specialty Care form is located at:  http://bcbstx.com/provider/pdf/record_of_referral.pdf

Specialist Referral Process
In-network specialists may refer members to other in-network specialists and professional providers by completing and faxing the Record of Referral to Specialty Care form. The Record of Referral to Specialty Care form is located at:  http://bcbstx.com/provider/pdf/record_of_referral.pdf.

Specialists and other professional providers are required to provide udpates to the member’s PCP (or referring physician) about the member's diagnosis and treatment plan. 

Claims Billing: Enter the referring provider's name in Box 17 along with the provider’s National Provider Identifier (NPI) in Box 17B on the CMS-1500 Claim Form.

Out of Network Care: All out of network care requires authorization. Contact Medical Management at 855-879-7178 or fax the Request for Prior Authorization form to 866-333-4827. The Request for Prior Authorization form is located at http://bcbstx.com/provider/pdf/preservice_review.pdf.

Member Self-Referrals

Members can self-refer for the following:

  • Diagnosis and treatment of sexually transmitted disease
  • Testing for the Human Immunodeficiency Virus (HIV)
  • Behavioral health services
  • Annual Well Women Exam (in-network only)
  • Prenatal services/obstetrical care (in-network only)
  • Family planning services to prevent or delay pregnancy

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 • April 19, 2013 • www.bcbstx.com