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Blue Review - Blue Cross and Blue Shield of Texas

July 19, 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.

72-Hour Emergency Overrides for Prior Authorization-Required Drugs

Federal and Texas law requires a pharmacy to dispense a 72-hour emergency supply of a prescribed drug when a medication is needed without delay and prior authorization (PA) is not available. This rule applies to non-preferred drugs on the Preferred Drug List (PDL) and any drug that is affected by clinical edits that would need the prescriber's prior approval. 

For more information on billing and reimbursement for 72-hour emergency prescriptions, reference the Provider Manual at http://bcbstx.com/provider/gri/manuals.html.

The PDL is available at http://www.txvendordrug.com/pdl/

Billing Requirements for Provider-Administered Drugs

A national drug code (NDC) and Healthcare Common Procedure Coding System (HCPCS) procedure code must be submitted on all medical claims for provider-administered drugs. If a submitted claim is missing the NDC information or the NDC is not valid for the corresponding HCPCS code, BCBSTX will deny or reject the entire claim for failing to comply with the Clean Claim Standards. This requirement applies to Medicaid (STAR) program only. 

For additional information on billing, view the How to Submit Claims for Physician Administered Drugs document located on the BCBSTX provider website at http://bcbstx.com/provider/medicaid/claims.html.

Sports and Camp Physicals

BCBSTX covers sports and camp physicals provided by network providers once a year to encourage youth participation in sports physical fitness programs and activities. This supports childhood obesity prevention activities in the service area by encouraging participation in physical activities. This benefit is available for all members 18 and under.

Sports and Camp physical billing
-  Provider should verify eligibility of assigned member
-  Provider will conduct a physical that meets the minimum requirements defined by a Sports or Camp physical
-  Bill with the lowest level of care , CPT code 99211, modifier 33, diagnosis V70.3
-  Provider will receive $20 for sports and camp physicals
-  Providers are not eligible for any additional payment for any services provided during a sports or camp physical

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 known 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] 

[PDF 141KB] 

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 designated of general internal medicine, family practice, or pediatrics and must attest to one of the following.
Read the details

New Website Look

The BCBSTX Medicaid (STAR) and CHIP website has a new look. Visit the new website at bcbstx.com/provider/medicaid/index.html to view all of the changes. The website can still be accessed by going to bcbstx.com, click the providers tab and then the Medicaid (STAR) and CHIP box at the bottom of the page. Look for more exciting updates to the website in the future.

Questions about Claims

Claim status may be checked anytime by logging on to the Availity®’ website at http://www.availity.com or by calling the Customer Care Center Interactive Voice Response (IVR) system at 888-292-4487.

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, 512-349-4881
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.

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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 • July 19, 2013 • www.bcbstx.com