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Blue Review - Blue Cross and Blue Shield of Texas

August 30, 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.

Flu Vaccine Procedure Code 90686 to Be a Benefit Effective Sept. 5, 2013
Effective for dates of service on or after Sept. 5, 2013, flu vaccine procedure code 90686 will be a benefit of Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid.

The following table shows the initial rates that will be implemented for procedure code 90686:

Type of Service (TOS)*
Age Range
Current Medicaid Fee
Current Adjusted Fee
Medicaid Fee
Effective 9/5/2013
Adjusted Fee
Not a benefit
Not a benefit
Informational - Available through Texas Vaccines for Children (TVFC)
Informational - Available through TVFC
Not a benefit
Not a benefit
Not a benefit
Not a benefit
Informational - Available through TVFC
Informational - Available through TVFC
Not a benefit
Not a benefit

TOS: 1=Medical Services, S=Texas Health Steps

Upcoming Webinar
Sept. 12, 2013 - A Comprehensive Overview

Join us for an overview of BCBSTX Medicaid (STAR) and CHIP. Appeals, claims filing, authorizations, case management and other topics will be discussed.

Date: Sept. 12, 2013

Time: Noon to 2 p.m.

Dial-in Attendance Information:
Step 1: Dial into the conference call at 866-308-0254. The passcode is 2142100850#.

Step 2: Log into the Live Meeting webinar at

Click on “Join Meeting” Button.

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

Magellan's Behavioral Health Disorders Toolkit for Primary Care Physicians
With physical and behavioral health so tightly entwined, consideration of your patient's behavioral health concerns has never been more essential for the delivery of integrated quality care. With this in mind, Magellan developed its Behavioral Health Disorders Toolkit, which contains:

  • descriptions of common behavioral health concerns
  • user-friendly screening tools for diagnosing behavioral health and substance use disorders
  • patient handouts
  • provider tip sheet
  • information materials

Organized by category, this online toolkit is designed to give medical practitioners the resources needed to identify potential behavioral health concerns and assist in making appropriate referrals. The toolkit represents our commitment to promote integration of medical and behavioral health services toward the goal of better overall outcomes for patients.

We encourage you to use the toolkit to help address the behavioral components of patient treatment and improve overall outcomes for Magellan members in your care. Visit www.MagellanPCPtoolkit.com.

Additional resources:


Magellan PCP Toolkit Handout, http://www.bcbstx.com/pdf/toolkit_handout.pdf.

Magellan PCP Toolkit: Bridging the Gap, information, http://www.bcbstx.com/pdf/bhpcp_toolkit.pdf.

CHIP and CHIP Perinatal Immunization Requirements

CHIP and CHIP Perinatal providers are expected to follow the below immunization-related requirements regarding the vaccine benefit and claims procedures.

  • Provider are expected to follow the immunization Standard Requirements set forth in Chapter 161, Health and Safety Code, relating to Texas Immunization Registry (ImmTrac), including parental consent on the Vaccine Information Statements.

  • Providers are expected to follow the standards in the Advisory Committee on Immunization Practices (ACIP) Immunization Schedule
    - CHIP Providers need to follow the AAP Periodicity Schedule for CHIP Members
  • If enrolled as a Texas Vaccines for Children (TVFC) provider, a CHIP provider serving CHIP-enrolled patients ages 18 and under can order and utilize TVFC immunization doses at no charge to the provider. The vaccine supply is provided by the Department of State Health Services, and the administration of the vaccine should be billed to Blue Cross Blue Shield Medicaid (STAR) and CHIP.

Please note: Providers need to indicate the vaccine administration AND the vaccine itself on the claim form. Providers should understand that they will not be reimbursed for the vaccine, but it must appear on the claim. Providers are also reminded of the importance of entering the immunization into ImmTrac.

For information on TVFC enrollment and ordering supplies go to:
https://www.dshs.state.tx.us/immunize/toolkit/kit1.shtm, or call the Immunization Branch at 512-776-3711; TVFC Provider Enrollment Fax: 512-776-7743.

Below are Frequently Asked Questions regarding vaccines for the CHIP perinatal clients (Mother/Perinate).

1. Are vaccines for the mother/Perinate (such as TDAP and flu) a covered benefit under CHIP Perinatal?
A. Yes, vaccines (such as TDAP and flu) are covered benefits of CHIP Perinatal.

2. Are vaccine costs built into the CHIP Perinatal premium?
A. Yes, cost for the vaccine serum and injection procedure are built into the CHIP Perinatal premium. CHIP Perinate providers should file a claim with the client's CHIP Perinatal health plan in order to receive reimbursement for the vaccine and injection.

3. Are CHIP Perinatal members prohibited from receiving vaccines from Adult Safety Net (ASN) or Texas Vaccine for Children (TVFC) because they should be receiving vaccines through their CHIP Perinatal Plan?
A. CHIP Perinatal members (above age 18) are prohibited from receiving vaccines from ASN and TVFC. CHIP Perinatal clients are considered to have health insurance coverage, and therefore are not eligible for the ASN. Likewise, CHIP perinatal clients over the age 18 do not meet the age requirements for TVFC.

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 30, 2013 • www.bcbstx.com