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Blue Review - Blue Cross and Blue Shield of Texas

May 31, 2013

For Travis Service-Area Medicaid (STAR) & CHIP Providers

Welcome to the Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR) & CHIP newsletter. Thank you for participating in BCBSTX Medicaid (STAR) & CHIP programs.


Texas Health Steps Update

The Child Health Clinical Record Forms were recently updated. These forms are intended for use as a documentation tool for all required checkup components and should never be given out as a client questionnaire. The forms are recommended for your use by Texas Health Steps; they are not required.

http://www.dshs.state.tx.us/thsteps/forms.shtm

The Texas Health Steps Risk Based Guidance Tool and the THSteps Medical Checkup Laboratory Requirements chart have been recently updated. The most current THSteps Medical Checkup Periodicity Schedule was revised April 2013.

http://www.dshs.state.tx.us/thsteps/providers.shtm


Increased Reimbursement for Medical Direction of Anesthesiologist Assistants Effective June 1, 2013

Effective for dates of service on or after June 1, 2013, anesthesiologists will receive an increased reimbursement when medically directing anesthesiologist assistants.  Anesthesiologists may be reimbursed 192 percent of the established reimbursement rate for medical direction by using one of the following modifier combinations: 

Modifier Combination
Submitted by
Anesthesiologist

 

When is it used?

 

Who will submit claims?

QY and U9

When medically directing one procedure provided by an anesthesiologist assistant.

Only the anesthesiologist

QK and U9

When medically directing two, three, or four concurrent procedures provided by anesthesiologist assistants.

Only the anesthesiologist

AD and U9 (Emergency circumstances only)

When medically directing five or more concurrent procedures provided by anesthesiologist assistants.  Used in emergency circumstances only and limited to 6 units (90 minutes) per case for each occurrence requiring five or more concurrent procedures.

Only the anesthesiologist

The increased reimbursement to the anesthesiologist includes the full reimbursement rate for medical direction and the full reimbursement rate for the anesthesiologist assistant, which is 92 percent of the anesthesiologist's rate.

For more information, call TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.


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


BCBSTX Medicaid (STAR) and CHIP Newsletter

Beginning June 7th, 2013, the Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR) & CHIP Newsletter will be issued every other week.


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)

Angela Rankin, angela_rankin@bcbstx.com, 512-349-4880
Facility/Ancillary Provider Network Representative

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.

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Blue Review Medicaid (STAR) & CHIP Update • May 31, 2013 • www.bcbstx.com