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Blue Review - Blue Cross and Blue Shield of Texas

March 29, 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.

Administrative Issues Contact Information
Submit paper claims to:
Blue Cross and Blue Shield of Texas
Attn: Claims
P.O. Box 684787
Austin, TX 78768 - 4787

Provider Complaints
Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
P.O. Box 684249
Austin, TX 78768 - 4787

Provider Appeals - Submit an appeal in writing using the Provider Dispute Resolution Form. Submit within 120 calendar days from receipt of the Remittance Advice (RA) or notice of action letter. The Provider Dispute Resolution Form is located at http://bcbstx.com/provider/pdf/provider_dispute.pdf.
Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
P.O. Box 684249
Austin, TX 78768

External Review - The provider may request an external review from a non-network provider of the same or related specialty. The provider must submit the request in writing to the below address:
Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
P.O. Box 684249
Austin, TX 78768

Advance Directives

Recognizing a person's right to dignity and privacy, our members have the right to execute a living will to identify their wishes concerning healthcare services should they become incapacitated. Physicians and professional providers may be requested to assist members in procuring and completing necessary forms. Refer to BCBSTX's website at http://bcbstx.com/provider/pdf/adv_dir.pdf for more information.

Also see www.dad.state.tx.us/news_info/publications/handbook/index.html for more information.

Personal Care Services (PCS)

Comprehensive Care Program providers that want to participate in the delivery of PCS to Medicaid clients must be enrolled with Texas Medicaid & Health Care Partnership (TMHP) and have the appropriate Texas Department of Aging and Disability Services (DADS) licensure or certification. All PCS providers must have a TPI and a National Provider Identifier (NPI). For more information on enrollment, contact TMHP at 800-925-9126.

PCS services are carved out of the Medicaid Managed Care Program for State of Texas Access Reform (STAR) clients and must be billed to TMHP for payment consideration. Carved-out services are those that are rendered to Medicaid Managed Care clients but are administered by TMHP and not the client's MCO.

Updating Provider Information
Plan providers are required to inform both BCBSTX and Maximus, the Administrative Services Contractor for Health and Human Services Commission, of any changes to their address, telephone number, group affiliation and other material facts.
  • BCBSTX via the Provider Information Change Form at bcbstx.com
  • Texas Medicaid and Healthcare Partnership (TMHP) via the Provider Information Change Form, available at http://www.tmhp.com

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 29, 2013 • www.bcbstx.com