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Blue Review - Blue Cross and Blue Shield of Texas

October 11, 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.

Upcoming Trainings
Please RSVP to any of the training sessions to: juanita_hill@bcbstx.com.

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

Providers serving Texas Medicaid (STAR) patients are required to register and attest their NPI with the Texas Medicaid & Healthcare Partnership (TMHP). Providers may have a claim reject or deny for “non-attestation”. This denial may be caused by one of the below reasons:

  • Provider not enrolled/failure to revalidate
  • License or certification revoked
  • Claims were submitted by a provider not fully enrolled by Health and Human Services Commission Medicaid
  • Provider requested to be removed
  • Failure to notify BCBSTX Medicaid (STAR) of change in status of TPI from ‘pending’ to ‘effective’
  • Provider not attested for the service they are providing, i.e. Texas Health Steps, Acute Care
  • Provider’s Texas Provider Identifier (TPI) is not linked to the correct location/address

To verify your attestation, contact the Texas Medicaid Healthcare and Partnership (TMHP) at 800-925-9126. If you believe your claim was denied in error due to attestation, contact the Customer Care Center at 888-292-4487.

Adding Providers to an Existing Group
To add a provider to an existing Medicaid (STAR) and/or CHIP contract, providers must complete and submit the Medicaid/CHIP Questionnaire. The completed Medicaid questionnaire may be faxed to the Medicaid Network Department at 512-349-4860 or via email to TexasMedicaidNetworkDepartment@bcbstx.com.

Pending Texas Provider Identifiers (TPIs)
Practices that submit request for providers to join the Medicaid (STAR) network and are pending TPIs, must notify the BCBSTX Medicaid Department once the TPI is received. Failure to notify BCBSTX Medicaid will result in a delay in joining the Medicaid (STAR) network. The effective date of your Medicaid (STAR) participation should be within two weeks of your notification to BCBSTX of the effective TPI number.

Prenatal Vitamins Available with Prescription
Prenatal vitamins are covered for females who are less than 50 years old. Physicians may write a prescription for the member for any prenatal vitamin listed on the formulary. A list of the preferred prenatal vitamins can be found on the Texas Vendor Drug site at http://www.txvendordrug.com/pdl. The preferred prenatal vitamins are found at the end of the Texas Preferred Drug List. Additionally, there is a formulary look-up tool located at http://www.txvendordrug.com/formulary/formulary-search.asp.

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 texasmedicaidnetworkdepartment@bcbstx.com

Providers will still be able to utilize the services of Availity®', www.availity.com, to verify eligibility.

Provider rosters
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.

Claims billing
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.

Member notification
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.

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
Shelby Robinson, shelby_robinson@bcbstx.com, 512-349-4897
Austin County, Bell, Burleson, Milam, Williamson ( Georgetown and Round Rock)

Britton Thibodeaux, britton_thibodeaux@bcbstx.com, 512-349-4898
Bastrop, Blanco, Caldwell, Colorado, Comal, Fayette, Gonzales, Guadalupe, Hays, Lavaca, Lee Washington

Dee Culver, deanna_culver@bcbstx.com, 512-349-4899
Burnet, Lampasas, Llano, San Saba, Travis, Williamson (except Georgetown, Round Rock)

Juanita Hill,  juanita_hill@bcbstx.com, 512-349-4896

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 • October 11, 2013 • www.bcbstx.com