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Blue Review - Blue Cross and Blue Shield of Texas

November 8, 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
The below training opportunities are targeted toward front office staff, clinical staff, and physicians. The trainings will offer valuable information for any office staff members that have direct contact with patients. Please RSVP to any of the training sessions to: juanita_hill@bcbstx.com.

Culturally Competent Medical Communications Cultural and Linguistic Presentation
Presenter:
Sara Daughtery-Pineda, RN, MSN, CPQH
When: Nov. 19, 2013
Where: Marie Callender's, 9503 Research Blvd #400, Austin, TX 78759
Time: Noon – 2 p.m.
RSVP: Nov. 18, 2013, at Noon

Children of Migrant Farmworkers Presentation
Presenter:
Sylvia Partida, National Center for Farmworker Health
When: Nov. 20, 2013
Where: Red Lobster, 3815 South Lamar Blvd., Austin, TX 78704
Time: Noon – 2 p.m.
RSVP: Nov. 19, 2013 at Noon.


Claim Payment Appeal Process

Request for claim payment appeals must be submitted in writing to Blue Cross and Blue Shield of Texas (BCBSTX) within 120 days of a claim disposition. Include all pertinent information. If additional information is required, BCBSTX will notify the provider of necessary information within 30 days of receipt of the appeal. The provider must return the information within 21 calendar days from the date of the request. If the information is not received within the 21 calendar days, we may close the case.

Use the Provider Dispute Resolution Request Form located at http://www.bcbstx.com/provider/pdf/provider_dispute.pdf.


Synagis

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.


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.

Blue Cross and Blue Shield of Texas (BCBSTX), a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

1001 E. Lookout Drive, Richardson, TX 75082

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Blue Review Medicaid (STAR) & CHIP Update • November 8, 2013 • www.bcbstx.com