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Blue Review - Blue Cross and Blue Shield of Texas

August 16, 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.


Billing Requirements for Provider Administered Drugs

A national drug code (NDC) and Healthcare Common Procedure Coding System 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, Blue Cross and Blue Shield of Texas (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, bcbstx.com/provider. Click the Medicaid (STAR) and CHIP navigation link and then Claims and Eligibility. Look on the right side of the page under Related Resources for the document.


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


CHIP Provider Responsibility

CHIP Providers are responsible for collecting any applicable copayments or deductibles at the time of service, in accordance with Children's Health Insurance Program (CHIP) cost-sharing limitations.

The CHIP Member's co-payment is listed on their ID card.

Families that meet the enrollment period cost-sharing limit requirement must report it to Maximus, at 877-543-7669, the Texas Health and Human Services Commission (HHSC) Administrative Services Contractor. Upon notification from Maximus that the cost-sharing limit has been reached, BCBSTX will issue the CHIP member a new member ID card within five days, showing that the member's cost-sharing limit has been met. No co-payments may be collected from these CHIP members for the balance of their term of coverage.


Electronic Funds Transfer

BCBSTX allows the electronic fund transfer (EFT) option for claims payment transactions. This allows claims payments to be deposited directly into a previously selected bank account. Providers may enroll by calling EDI services at 800-746-4614.


Balance Billing
BCBSTX’s Participating Provider Agreement prohibits providers from billing or collecting any amount from Medicaid members for health care services provided.

Federal and state laws impose severe penalties for any provider who attempts to bill or collect any payment from Medicaid recipients for covered services.


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 the details


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.


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
If the member is unable to reach Sonia, please contact Consuelo Izquierdo, consuelo.izquierdo@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 • August 16, 2013 • www.bcbstx.com