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Blue Review - Blue Cross and Blue Shield of Texas

August 2, 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.

Initial Health Assessment
Primary Care Providers (PCPs) or other professional providers should perform an Initial Health Assessment (IHA) with new members within 90 days of enrollment in BCBSTX. The IHA consists of:

1. A history and physical examination.
2. A developmental assessment.

An IHA is not necessary if the member is an existing patient of the PCP group (but new to the BCBSTX plan). Follow-up is not required if there is an established medical record that shows a baseline health status. This record must include sufficient information for the PCP to understand the member's health history and to provide treatment recommendations as needed. Transferred medical records can meet the requirements for an IHA if a completed health history is included.


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


Office Hours

To maintain continuity of care, the physician or other professional provider must be available 24 hours a day by telephone or have an on-call physician or other professional provider take calls. Office hours must be conspicuously posted and members must be informed about the provider's availability at each site. Please review the Medical Appointment Standards in the Access to Care chapter of the Provider Manual at bcbstx.com/provider/medicaid/education_reference.html


Advance Directives

Recognizing a person's right to dignity and privacy, our members have the right to execute a living will to identify their wishes concerning health care services should they become incapacitated. Physicians and/or providers may be requested to assist members in procuring and completing necessary forms. Refer to the BCBSTX website at bcbstx.com/provider/medicaid/materials.html. Under the Other listing, click Advance Directives for more information.

Also see www.dads.state.tx.us/news_info/publications/handbooks/index.html.


Updating Provider Information

Plan providers are required to provide notice of any changes to their address, telephone number, group affiliation and/or any other material facts, to the following entities:

• BCBSTX via the Provider Information Change From on the BCBSTX provider website at bcbstx.com/forms/provider/update_info.html
• Health and Human Services Commission's administrative services contractor, Maximus
• Texas Medicaid and Healthcare partnership (TMHP) via the Provider Information Change From, available at http://www.tmhp.com

Claims payment will be delayed if the following information is incorrect:

- Demographics - billing/mailing address (Medicaid (STAR) and CHIP)
- Attestation of TIN/rendering and billing numbers for acute care (Medicaid (STAR))
- Attestation of TIN/rendering and billing numbers for Texas Health Steps (Medicaid (STAR))

 
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.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

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Blue Review Medicaid (STAR) & CHIP Update • August 2, 2013 • www.bcbstx.com