|September 27, 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.
Please RSVP to any of the training sessions to: firstname.lastname@example.org.
OB/GYN Claims and Billing
When: Oct. 10, 2013
Where: BCBSTX, 9442 Capital of Texas Hwy N. Suite 500, Arboretum Plaza II, Austin, TX 78759
Time: Noon – 2 p.m.
RSVP: Oct. 8, 2013, by 5 p.m.
Texas Health Steps Presentation hosted by BCBSTX, Sendero, Seton, & Superior Health Plans
Presenter: Deneice Pryor, Provider Representative for Texas Health Steps from the Texas Department of State Health Services
When: Oct. 22, 2013
Where: Red Lobster, 109 W Anderson Lane, Austin, TX 78752
Time: Noon – 2 p.m.
RSVP: Oct. 21, 2013 at Noon.
Claims, Billing, and Authorization
When: Oct. 31, 2013
Where: Marie Callender's, 9503 Research Blvd #400, Austin, TX 78759
Time: Noon – 2 p.m.
RSVP: Oct. 30, 2013 at Noon
CHIP into Tiers
Since the initiation of CHIP in Texas, eligibility has been determined by a state contractor using a separate system from Medicaid. The Health and Human Service Commission (HHSC) will transition the processing of CHIP applications into the state’s TIERS (Texas Integrated Eligibility Redesign System) eligibility system, the system currently used for Medicaid.
What does this mean for providers?
By Oct. 1, 2013 all active CHIP members will have a new CHIP ID number as result of the CHIP into Tiers conversion. The new ID number will be a 9-digit numeric number (as opposed to the current alphanumeric ID number). Since the new CHIP ID number looks exactly like a Medicaid ID, it is imperative that providers verify eligibility to determine if the member is enrolled in CHIP or Medicaid.
NOTE: BCBSTX member ID cards contain an identifying Alpha Prefix:
- ZGT – Medicaid (STAR)
- ZGC – CHIP
- ZGE – CHIP Perinate
CHIP perinatal exception
CHIP perinatal clients who enroll on or after Sept. 3, 2013, will immediately be assigned a new CHIP ID number, which providers may begin using to bill services. BCBSTX will mail new member Identification cards to members on or around Oct. 1, 2013, with an explanation of the change.
Verifying eligibility/new ID crosswalk
In the event the member does not present their new identification card during a visit, providers must verify eligibility before rendering services. Additionally a crosswalk is available to providers to match member legacy CHIP alphanumeric numbers to new CHIP ID numbers via the resources below:
- Contacting BCSBTX Customer Care Center at 888-292-4487
- Contacting the State’s Provider Hotline at 800-645-7164
- Contacting your Local Network Provider Representative via email at email@example.com
Providers will still be able to utilize the services of Availity®', www.availity.com, to verify eligibility.
Provider rosters, beginning the month of October, will include the new CHIP ID number only. The October provider roster will be distributed late September or early October.
Providers should begin submitting claims utilizing the member’s new CHIP ID on Oct. 1, 2013. This applies to claims with a date of service of Oct. 1, 2013, and after. Claims with a date of service prior to Oct. 1, 2013, should be submitted with the legacy CHIP Alpha/Numeric Identification number. If a claim with a date of service on or after Oct. 1, 2013, is received with the old CHIP Alpha/Numeric number, the claim will still process, however, the EOB/ERA will be issued with the new CHIP Numeric only Identification Number. The above billing instructions also apply to appeals of previously submitted claims.
The only exception to the above billing instructions is for CHIP perinatal clients who are enrolled on or after Sept. 3, 2013. These clients will be assigned a new CHIP ID number and providers must submit claims referencing that number.
HHSC will send two notifications to members: once prior to the conversion and again after the conversion. The target date for the first member notification is late August.
Note: The above information also applies to CHIP Perinate.
For additional questions, contact the Customer Care Center at 888-292-4487.
RSV season will soon be here. Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid and CHIP will be following the Texas Pediatric Society (TPS) Infectious Disease Committee RSV Task Group recommendations for administration of Synagis. The recommendations are based on more than 10 years of epidemiologic data for each of the DSHS Regions, and the 2009 AAP guidelines noted in the 2012 Redbook.
For Region 7, Austin and the Travis Service Area, the dates for administration of Synagis are Oct. 1, 2013, to March 1, 2014. AAP guidelines recommend a maximum of five doses of Synagis and note that the last dose should provide good protection for four weeks, allowing the child to be covered for the remainder of the season. TPS suggests, if possible, waiting to start prophylaxis until the arrival of RSV in the area to allow more efficient use of Synagis. The TPS information and epidemiologic updates are available on the TPS website: http://txpeds.org/rsv-data.
In summary, BCBSTX will implement the TPS recommendations with a maximum of 5 doses of Synagis for the highest risk infants and use the dates of Oct. 1, 2013, to March 1, 2014.
DTaP and Tdap Vaccines Are Benefits of Texas Medicaid and Available through TVFC
Because of the recent pertussis outbreak, providers are reminded that immunization against pertussis is a benefit of Texas Medicaid for pregnant women and their babies. Younger children can be immunized with one of several DTaP vaccines that are a benefit of Texas Medicaid. Older Children, adolescents and adults can be immunized with Tdap vaccines. Most of these vaccines are available through Texas Vaccines for Children (TVFC) for clients who are 18 years of age or younger.
The procedure codes in the following table are benefits of Texas Medicaid:
|Procedure Code ||Vaccine ||Available through TFVC |
|90696 ||DTaP-IPV ||Yes |
|90698 ||DTaP-IPV-Hib ||Yes |
|90700 ||DTaP ||Yes |
|90715 ||Tdap ||Yes |
|90721 ||DtaP-Hib ||Yes |
|90723 ||DTaP-Hep B-IPV ||Yes |
For clients who are 18 and younger, Texas Medicaid does not reimburse for vaccines that are available through TVFC, because TVFC provides the vaccine to providers; however, providers may be reimbursed by Texas Medicaid for the administration of the vaccine. On claims for TVFC-clients, the vaccine procedure codes are processed as informational.
Current Pertussis Outbreak in Texas
For additional information about the pertussis outbreak, providers can refer to the Department of State Health Services (DSHS) bulletin www.dshs.state.tx.us/news/release/20130830.aspx.
Providers can refer to the Centers for Disease Control and Prevention (CDC) website at www.cdc.gov/vaccines/vpd-vac/pertussis/ for additional information about pertussis or whooping cough.
Availity Clearinghouse Changes
The following bulletin was posted on www.tmhp.com June 14, 2013.
Availity has announced planned changes to their clearinghouse services for government and non-sponsored health plan transactions in Texas. The announcement states that “Availity plans to no longer support free government transactions and non-sponsoring health plan transactions, effective August 4, 2013, for Texas submitters (not applicable to BCBSTX – see below),” including, but not limited to, Texas Medicaid claims.
Texas Medicaid providers that use Availity’s clearinghouse services may be impacted by these changes. Providers can refer to the Frequently Asked Questions, https://support.availity.com/entries/23700152-Important-Texas-EDI-Government-Transactions, document that is posted on the Availity website or contact Availity for more information.
The above Availity changes will not affect BCBSTX Medicaid (STAR) and CHIP claims. BCBSTX Medicaid (STAR) and CHIP claims are submitted as a Blue Commercial transaction and not as government transactions.
If you have any questions, please contact the Texas Medicaid Network Department at 512-349-4876.
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
Provider Customer Service: 888-292-4487, 7 a.m. to 6 p.m. CT, Monday through Friday
For general questions and concerns:
Jamye Rushing, firstname.lastname@example.org, 512-349-4876; Fax: 512-349-4848
Network Provider Representatives
Shelby Robinson, email@example.com, 512-349-4897
Austin County, Bell, Burleson, Milam, Williamson ( Georgetown and Round Rock)
Britton Thibodeaux, firstname.lastname@example.org, 512-349-4898
Bastrop, Blanco, Caldwell, Colorado, Comal, Fayette, Gonzales, Guadalupe, Hays, Lavaca, Lee Washington
Dee Culver, email@example.com, 512-349-4899
Burnet, Lampasas, Llano, San Saba, Travis, Williamson (except Georgetown, Round Rock)
Juanita Hill, firstname.lastname@example.org, 512-349-4896
Angela Rankin, email@example.com, 512-349-4881
Facility/Ancillary Provider Network Representative
Clinical Outreach & Education, Quality/Compliance
Kathy Clark, firstname.lastname@example.org, 512-349-4880
For Member Outreach inquiries, BCBSTX Medicaid (STAR) and CHIP members may contact
Sonia Saenz, Senior Outreach Specialist/Member Advocate, email@example.com, 512-349-4883
If the member is unable to reach Sonia, please contact Consuelo Izquierdo, firstname.lastname@example.org, 512-349-4887.