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Blue Review - Blue Cross and Blue Shield of Texas

May 24, 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.

Ancillary Training to HEDIS 101 for Providers Training
Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR) and CHIP is hosting a HEDIS 101 for Providers presentation. The training will focus on:
  • Defining HEDIS
  • What is the provider’s role?
  • HEDIS measures
  • HEDIS physician documentation
  • and more . . .
Guest Presenter: Sara Daugherty-Pineda, RN, MSN, CPHQ
Date: May 30, 2013
Time: Noon to 2 p.m.
Location: Marie Callender's, 9503 Research Blvd #400, Austin, TX 78759

RSVP Deadline: May 29, 2013, by noon; email juanita_hill@bcbstx.com or call 512-349-4896

Lunch will be provided.

Contracted Providers

Only Medicaid attested providers and laboratories are eligible for reimbursement under the Medicaid Program. Providers must ensure referrals are to Medicaid attested providers and Medicaid attested laboratories. BCBSTX Medicaid (STAR) and CHIP is currently contracted with the following:

Clinical Pathology Laboratories
NTD Laboratories (Effective 6/1/2013)
Quest Diagnostic Clinic Lab

Advanced Imaging San Marcos
Austin Cancer Centers
Austin Open MRI, LLP
Austin Radiological Associates
CardioStaff Corporation
Central Texas Imaging
Central Texas Open MRI
Preferred Imaging of Round Rock
River Ranch Radiology
South Austin Health Imaging, LLC
Synergy Advanced Imaging, Ltd.

Cedar Park Regional Medical Center
Central Texas Medical Center
Dell Children’s Medical Center
Heart Hospital
Little River Healthcare
Memorial Hospital
North Austin Medical Center
Round Rock Medical Center
Seton Edgar B. Davis
Seton Highland Lakes
Seton Medical Center
Seton Medical Center Hays
Seton Medical Center Williamson
Seton Northwest Hospital
Seton Smithville Regional Hospital
Seton Southwest
St. David’s Georgetown Hospital
St. David’s Medical Center
St. David’s South Austin Medical Center
St. Marks Medical Center
University Medical Center Brackenridge

Attestation Form Now Available for Qualified Primary Care Providers to Receive ACA 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 internal medicine, family practice, or pediatrics and must attest to one of the following.
Read more


Weekly Newsletter
The BCBSTX Medicaid (STAR) & CHIP weekly newsletter will no longer be issued on a weekly basis. The newsletter will now be issued on a bi-weekly basis beginning June 7, 2013.

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.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

1001 E. Lookout Drive, Richardson, TX 75082

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Blue Review Medicaid (STAR) & CHIP Update • May 24, 2013 • www.bcbstx.com