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Blue Review - Blue Cross and Blue Shield of Texas

April 26, 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.

Children of Migrant Farmworkers
Children of migrant farmworkers due for a Texas Health Steps medical checkup can receive their periodic checkup on an accelerated basis prior to leaving the area. A checkup performed under this circumstance is an accelerated service, but it should be billed as a checkup. Performing a make-up exam for a late Texas Health Steps medical checkup previously missed under the periodicity schedule is not considered an exception to periodicity or an accelerated service. It is considered a late checkup.

Children of migrant farmworkers will be identified by the plan and assisted in receiving accelerated services, if necessary, prior to migration. BCBSTX Medicaid has created an assessment tool, Migrant Farmworker Questionnaire, to aide providers in identifying children of migrant farmworkers who may travel to other parts of the country. The Migrant Farmworker Questionnaire can be accessed by clicking here: http://bcbstx.com/provider/pdf/migrant_farmworker.pdf.

Medical Transportation Services

BCBSTX offers non-emergency transportation services to BCBSTX CHIP members to access covered services and health education classes when other transportation is not readily available or it is not feasible for a member to use existing transportation. This benefit assists members in keeping medical appointments and helps improve health outcomes. Members may call 888-292-4480 to schedule transportation.

Medicaid (STAR) members should utilize the Texas Medical Transportation Program (MTP) to receive non-emergency transportation to access medical appointments, dental appointments and the pharmacy. Medicaid (STAR) members should call 877-MED-TRIP (877-636-8747) to arrange transportation.

Medicaid (STAR) members are only eligible for BCBSTX transportation service when the MTP service is unavailable or when the member needs assistance coordinating with the Texas Medical Transportation Program.

Medicaid Formulary and Preferred Drug List

BCBSTX uses the Texas Vendor Drug Program Preferred Drug List. The formulary lists the brand name or generic name of a given drug. If a medication does not appear on this formulary, the medication is not covered under the pharmacy benefit. Providers may search the formulary at the Texas Vendor Drug Program Site, www.txvendordrug.com/formulary.

The formulary is also available for Smart phones through Epocrates at www.epocrates.com.

Cultural and Linguistic Provider Resources

BCBSTX recognizes the importance of providing culturally and linguistically appropriate health care related services to members. To support providers in this effort, BCBSTX has provided educational material on providing culturally competent care. The Culturally Competent Toolkit is available at http://bcbstx.com/provider/pdf/cultural_competency.pdf.

The Culturally Competent Toolkit is a 48-page manual that is designed for use by physicians and health care professionals, titled Caring for Diverse Populations, Better Communication, Better Care.

The following topics are addressed in the manual:

  • Resources to Assist Communication with a Diverse Patient Population Base - Encounter tips for providers and their clinical staff, a system to assist with patient interviews, help in identifying literacy programs and an interview guide for hiring clinical staff who have an awareness of cultural competency issues.
  • Resources to Communicate Across Language Barriers - Tips for locating and working with interpreters, common signs and common sentences in many languages, language identification flashcards and language skill self-assessment tool.
  • Resources to Increase Awareness of Cultural Background and Its Impact on Health Care Delivery - Tips for talking with a wide range of people across cultures about a variety of culturally sensitive topics and information about health care beliefs of different cultural backgrounds.
  • Regulations and Standards for Cultural and Linguistic Services - Some key legislation and a summary of the "Culturally and Linguistic Appropriate Service (CLAS) Standards," which serve as a guide on how to meet these requirements.
  • Resources for Cultural and Linguistic Services - A bibliography of print and Internet resources for conducting an assessment of the cultural and linguistic needs of your own practice's patient population, staff and physician cultural and linguistic competency training resources - plus links to additional tools in multiple languages and/or written for limited English proficiency.

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.

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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 26, 2013 • www.bcbstx.com