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Blue Review - Blue Cross and Blue Shield of Texas

November 22, 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.

Provider Training
Behavioral Health Toolkit Presentation for Primary Care Physicians
Primary care physicians (PCP) must have behavioral health screening and evaluation processes in place that are appropriate for detection, treatment or referral of members. PCPs are responsible for documenting in medical records any referrals and any known self-referrals for behavioral health providers. This presentation will provide information on bridging the gap between medical and behavioral health and discuss the PCP toolkit that is available for providers by Magellan.

Please RSVP to the training session to: juanita_hill@bcbstx.com.

When: Dec. 10, 2013
Where: Marie Callender's, 9503 Research Blvd #400, Austin, TX 78759
Time: Noon – 1 p.m.
RSVP: Dec. 9, 2013, at Noon

Combat Childhood Obesity with New Provider Tools Located Online
Blue Cross and Blue Shield of Texas (BCBSTX) would like to take this opportunity to thank you for the care you give to your patients who are our members. Because we recognize the importance of your efforts, we are always looking for ways to help you as you help our members achieve better health outcomes.

BCBSTX is offering a free, online Body Mass Index (BMI) training to assist you with just such a goal in mind. This course is designed for physicians, nurse practitioners, physician assistants, registered nurses, licensed vocational nurses, medical assistants and registered dieticians.

The online training includes step-by-step instructions on how to calculate and plot BMI percentiles for children and adolescents. The training also provides an interactive, hands-on practice as well as access to the following tools:

  • A virtual BMI calculator wheel
  • Centers for Disease Control BMI growth charts
  • American Medical Association Expert Committee Recommendations
  • Motivational interviewing tips
  • Preventive health care forms

Access to this training is available at www.BMI4kids.info. Upon completion of the training, you will receive a certificate of completion.

Texas Health Steps Benefits
Texas Health Steps provides payment for comprehensive and periodic evaluations of a child's health, development and nutritional status, as well as vision, dental and hearing services for STAR recipients from birth to 20. The periodic medical evaluations are based on American Academy of Pediatrics (AAP) recommendations for preventive health care with modifications to meet federal or state regulations. BCBSTX provides medical screening visits for children in the STAR program from birth to 20 years of age and the CHIP program from birth through 18 years of age.

For additional information on Texas Health Steps screening requirements, additional checkups, autism screening and more, visit: http://www.bcbstx.com/pdf/health_steps_ben.pdf.


Self-Referrals

STAR members may access the following services at any time without prior-authorization or referral by their PCP:

  • Diagnosis and treatment of sexually transmitted diseases (STDs)
  • Testing for the human immunodeficiency virus (HIV)
  • Family Planning Services: Services from any Medical Family Planning provider to prevent or delay pregnancy
  • Provider, in-or-out of network
  • Annual Well Woman Exam (ICD Diagnosis code V72.3) (In network only)
  • Prenatal services (In network only): Obstetric care unless the member is in the third trimester
  • Early Childhood Intervention (ECI): Only initial evaluation does not require prior-authorization or referral by PCP
  • Vision services provided by Davis Vision

Synagis
RSV (Respiratory Syncytial Virus) season is 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.

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Blue Review Medicaid (STAR) & CHIP Update • November 22, 2013 • www.bcbstx.com