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Blue Review - Blue Cross and Blue Shield of Texas

June 21, 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.

There will not be a newsletter on Friday, July 5. We will resume publication on July 19.

Temporary Medicaid Eligiblity Verification Form (1027-A)
Medicaid clients may present the Temporary Medicaid Eligibility Verification form (1027-A) as evidence of Medicaid eligibility. While this form might not have a Medicaid number, it is an official state eligibility document and can be relied upon as proof of Medicaid eligibility until the family receives the Medicaid Identification form.


Mailback Form

Blue Cross and Blue Shield of Texas (BCBSTX) sends a request for additional or corrected information to providers when the claim received cannot be processed due to incomplete, missing or incorrect information in the original claim submission.

The request for information includes a form that allows providers to return the requested information in an easy-to-follow format. This form is called a "mailback" form. This form must be returned with the requested information in order to process the claim. Providers have 21 calendar days from the date on the mailback to submit the corrected claim information to BCBSTX. The provider then has 120 days from the date of the first denial to appeal the claim.

BCBSTX also may request additional information retroactively for a claim that has already been paid. The mailback form is also used for these situations.

If providers receive a request from BCBSTX for additional information, providers must provide this information within 21 calendar days from the date of the request or the claim may be denied.


Case Management

The BCBSTX Case Management department offers expert assistance in the coordination of complex healthcare. Case Management is provided at no cost to the member or provider.

Case Management is a collaborative process that assesses, develops, coordinates, monitors and evaluates care plans designed to optimize members’ healthcare benefits and promote quality outcomes.

The Case Manager, through interaction with the member, member representatives and/or providers, collects and analyzes data and information about the actual and potential care needs for the purpose of developing a care plan. Cases may be identified by disease state or condition, dollars spent or high utilization of services.

Referral Process
Physicians and other professional providers, nurses, social workers and members or their representatives may refer members for case management in one of two ways:

  • Call Case Management at 855-879-7178
  • By faxing a completed Case Management Referral Form, http://www.bcbstx.com/provider/pdf/case_mgmt_ref.pdf, to 866-333-4827; a Case Manager will respond to the person who submitted the faxed request within three business days


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


New Website Look

The 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.


Questions about Claims

Claim status may be checked anytime by logging on to the Availity website at www.availity.com or by calling the Customer Care Center Interactive Voice Response (IVR) system 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, 512-349-4881
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 • June 21, 2013 • www.bcbstx.com