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Blue Review - Blue Cross and Blue Shield of Texas

October 25, 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.

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

HEDIS 101 for Providers
When: Nov. 5, 2013
Where: Marie Callender’s, 9503 Research Blvd. #400, Austin, TX 78759
Time: Noon – 2 p.m.
RSVP: Nov. 3, 2013 at Noon.

Behavior Health Screening and Information Articles

Blue Cross and Blue Shield of Texas (BCBSTX) requires that all physicians and other professional providers have screening and evaluation procedures for the detection and treatment of, or referral for, any known or suspected behavioral health problems or disorders. Physicians and other professional providers may provide any clinically appropriate behavioral health services within the scope of their practice. Magellan provides behavioral health services for the BCBSTX Medicaid (STAR) and CHIP program. We encourage providers to read the following articles for additional education and resources.

Magellan Behavioral Health Services Extends Motivational Interviewing to Clients

Magellan and the Children’s Mental Health Network Raise Awareness about Issues Pertaining to Mental Health and Youth

After Hours Accessibility

The Texas Health and Human Services Commission (HHSC) and Texas Department of Insurance (TDI) require all managed care organizations to monitor after-hours accessibility periodically, but no less than annually. Primary Care Providers must have an after-hours system in place to help ensure that the Member can reach his or her PCP or an on-call physician with medical concerns or questions.

Acceptable after-hours call coverage arrangements are:

  • The office telephone is answered after normal business hours by an answering service that can contact the PCP or another designated medical practitioner. The PCP or his/her designee must be available to return calls answered by the answering service within 30 minutes.
  • The office telephone is answered after normal business hours by a recording directing the member to call another number to reach the PCP or another designated medical practitioner. Someone must be available to answer the designated provider's telephone. Another recording/answering machine is not acceptable.
  • The office telephone is transferred after normal business hours to another location where a live person answers the phone and can contact the PCP or another designated medical practitioner. The PCP or his/her designee must be available to return calls within 30 minutes.

The following are considered unacceptable after-hours call coverage arrangements:

  • The office telephone is not answered after normal business hours.
  • The office telephone is answered after normal business hours by a machine which instructs members to leave a message.
  • The office telephone is answered after normal business hours by a machine that instructs patients to go to the emergency room.
  • Messages or pages are not returned within 30 minutes.

BCBSTX prefers that the PCP use plan-contracted, in-network physicians or other professional providers for on-call services. When that is not possible, the PCP must use best efforts to help ensure that out-of-network on-call physicians or other professional providers abide by the terms of the BCBSTX provider contract.

BCBSTX monitors PCP compliance with after-hours access standards on a regular basis. Failure to comply with after-hours access standards may result in corrective action.


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.

National Drug Code (NDC) Crosswalk

Effective immediately, BCBSTX Medicaid (STAR) and CHIP will no longer use the Noridian crosswalk.

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 • October 25, 2013 • www.bcbstx.com