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Blue Review - Blue Cross and Blue Shield of Texas

June 7, 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.

New Website Look
The Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR) and CHIP website has a new look. Visit the new website at http://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.

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 at http://bcbstx.com/provider/network/updates.html.

Common Reasons for Rejected and Returned Claims
Many of the claims returned for further information are returned for common billing errors.
See the chart of reasons

Sports and Camp Physical Value Added Service

BCBSTX covers Sports and Camp physicals provided by network providers once a year to encourage kid's 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 to all members aged 18 and under.

When billing Sports and Camp physicals:
  • The provider should verify the eligibility of assigned members and verify that the member has not already received a Sports and Camp physical within the last year.
  • The provider will conduct a physical that meets the minimum requirements defined by a Sports or Camp physical.
  • The provider will bill the lowest level of care, CPT code 99211, modifier 33, along with Diagnosis Code V70.3.
  • Providers will receive $20 for Sports and Camp physicals that meet the criteria.
  • Providers are not eligible for any additional payment for any service provided during a Sports or Camp physical.

Claim Status Inquiry and Follow-up
Checking Claim Status
Providers should receive a response from BCBSTX within 30 business days of receipt of claim. If the claim contains all required information, BCBSTX enters the claim into BCBSTX's claims system for processing and sends you a Remittance Advice (RA) or Claims Disposition Notice (CDN) at the time the claim is finalized.

Claim Status Online
You can confirm BCBSTX 's receipt of your claim through the Availity®’ online tool at www.availity.com. Using Availity, you can also view claims status and payment information.

IVR Claim Status
Providers can also confirm that BCBSTX received their claim through our Interactive Voice Response (IVR). Call the BCBSTX Customer Care Center (CCC) at 888-292-4487. CCC hours are Monday through Friday, 7 a.m. to 6 p.m. (Central Time), except certain holidays.

Claim Follow-Up/Resubmission
Providers can initiate follow-up action to determine claim status if there has been no response from BCBSTX to a submitted claim after 30 business days from the date the claim was submitted.

To follow-up on a claim, providers should:
  • Check www.availity.com or the IVR for disposition of the claim. Please note that the IVR accepts either your billing National Provider Identifier (NPI) or your federal Tax Identification Number (TIN) for Provider Identification. Should the system not accept your billing NPI or Federal TIN, the system will route your call to a CCC representative who will help you with your query. For purposes of assisting the provider, the CCC representative may ask for the TIN.
  • Contact the CCC.
  • Provide a copy of the original claim submission and all supporting documentation (such as records and reports) that you deem pertinent or that has been requested by BCBSTX to:
    Blue Cross and Blue Shield of Texas
    Attn: Claims
    P.O. Box 684787
    Austin, TX 78768-4787

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
Effective June 7, 2013, the BCBSTX Medicaid (STAR) & CHIP newsletter will be issued every other week.

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 • June 7, 2013 • www.bcbstx.com