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Blue Review - Blue Cross and Blue Shield of Texas

December 6, 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 Physician
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 any of the training sessions 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

Texas Health Steps Free Online Provider Education
Texas Health Steps offers a variety of continuing education courses for providers and clinical staff. The online program also offers Free CE (continuing education) courses. The courses are arranged by topic. Some of the topics covered are:

  • Acute and Chronic Medical Conditions
  • Adolescent health
  • Pediatric referral guidelines
  • Developmental and mental health screening
  • Overview of best practices and children's services
  • and more

Synagis
RSV (respiratory syncytial virus) season is here. 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 five doses of Synagis for the highest risk infants and use the dates of Oct. 1, 2013, to March 1, 2014.


Correction to Self-Referrals Article from Nov. 22, 2013, Newsletter

The self-referrals article incorrectly stated that members may self-refer to a provider, in or out of network. This is incorrect. The article should have stated, members may self refer to any Medical Family Planning Provider, in or out of network for Family Planning Services to prevent or delay pregnancy.


Weekly Newsletter Update

The BCBSTX Medicaid (STAR) and CHIP newsletter will no longer be issued on a bi-weekly basis. The January 2014 newsletter will be issued on Jan.10. Beginning in February, the newsletter will be issued the first Friday of every month.


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 Anselmi, angela_anselmi@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 • December 6, 2013 • www.bcbstx.com