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Blue Review - Blue Cross and Blue Shield of Texas

May 10, 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.

Texas Health Steps Provider Outreach Referral Form
Effective April 1, 2013, the Texas Health Steps Provider Outreach Referral Form should be used by all Texas Health Steps providers who submit a request for outreach on behalf of one of their Texas Health Steps patients as it replaces the Texas Health Steps Missed Appointment Referral Form.

Texas Health Steps providers may use the referral form when submitting a request for outreach through the Texas Health Steps Provider Outreach Referral Service. This service, previously know as the Texas Health Steps Missed Appointment Referral Service, should be used when a Texas Health Steps patient needs to be seen for a follow-up, needs to have a missed appointment rescheduled, needs assistance scheduling transportation or requires other patient-related outreach services.

Texas Health Steps providers who have questions about this new referral form, or need information about the Texas Health Steps Provider Outreach Service, should contact the appropriate Texas Health Steps provider relations representative in their region. The names and contact information of the representatives can be found at

Texas Health Steps Provider Outreach Referral Form [Word 133KB]
Texas Health Steps Provider Outreach Referral Form [PDF 1.01MB]

Instructions [PDF 141KB]

Attestation Form Now Available for Qualified 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 designation of general medicine, family practice or pediatrics. For further information on the Attestation Process, to access the Texas Medicaid Attestation for ACA Primary Care Rate Increase and ACA Frequently Asked Questions (FAQ), visit the Texas Medicaid & Healthcare Partnership website at http://www.tmhp.com/Pages/Topics/ACA.aspx.

Texas Health Steps Autism Screening

Texas Health Steps (THSteps) added a new autism screening to the existing developmental screening, using specific, standardized screening tools. Developmental screening is already a part of the program exams. Standardized screening for autism was added as a new benefit. Both screens are needed because the existing developmental screenings may not detect behavior that would identify the need for further evaluation for autism. The autism tool may be viewed at www.firstsigns.org/downloads/m-chat.PDF.

Providers are required to bill these two screenings separately from the checkup when performed on the same day. While developmental screening is a required component of the program visits, BCBSTX Medicaid (STAR) and CHIP currently does not reimburse separately for developmental or autism screening.

The CPT code for developmental screening is 96110.
The CPT code for autism screening is 96110 with a U6 modifier.

For more information on Billing Instructions for Developmental and Autism Screenings, go to http://bcbstx.com/provider/network/medicaid.html, Education Materials, Texas Health Steps Benefits.

Update: Change in Services Requiring Prior Authorization, Effective Aug. 1, 2013

Services Requiring Prior Authorization
Effective Aug. 1, 2013, Blue Cross and Blue Shield of Texas (BCBSTX) is updating the list of codes related to services that require prior authorization (PA) before they can be provided to our members enrolled in Medicaid (STAR) and CHIP. The following service categories are affected by this update:

  • High tech radiology
  • Pain management injections and procedures
  • Prosthetic/orthotic devices
  • Sleep studies
  • Tonsillectomy and adenoidectomy

A more comprehensive list of services requiring PA will be available at bcbstx.com/provider/network/medicaid.html on July 1 by the following steps:

  1. Scroll down and select the Prior Authorization Requirements tab.
  2. Select the Services Requiring Prior Authorization document.

Reminder: Verifying Eligibility and Benefits Reduces Denied Claims
As a reminder, providers are responsible for verifying eligibility and benefits before providing services to BCBSTX members. Except for an emergency, failure to obtain prior authorization for these services may result in a denial for reimbursement. To verify member eligibility and benefits, please call our Customer Care Center at 888-292-4487.

In addition, please remember that BCBSTX will review all non-urgent prior authorization requests within three business days. Prior authorization decisions for urgent requests will be made within 72 hours from receipt of the request. BCBSTX does not require authorization for treatment of emergency medical conditions; however, providers are required to contact BCBSTX within 24 hours of the admission.

To verify specific prior-authorization code requirements for a particular member, call 888-292-4487.

Where to Find our Medical Policies and Clinical UM Guidelines
To learn more about medical policies and clinical Utilization Management guidelines, please visit our website at bcbstx.com/provider/network/medicaid.html and scroll down to select Medical Policies.

For Prior Authorization or More Information
To request prior authorization, report a medical admission or ask questions regarding prior authorization, please contact the BCBSTX Utilization Management department at 855-879-7178. You also may fax prior authorization requests to 855-879-7180.

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 Member Outreach at 800-618-3084.


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 • May 10, 2013 • www.bcbstx.com