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Blue Review - Blue Cross and Blue Shield of Texas

February 7, 2014

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 Provider Training

Topic: OB/GYN Claims and Billing
Date:  Feb. 21, 2014
Place:  Red Lobster, 3815 S Lamar Blvd, Austin, TX 78704
Time:  Noon to 2 p.m.
RSVP:  February 20 by noon

Topic: Claims and Billing
Date:  Feb. 28, 2014
Place:  Marie Callender's, 9503 Research Blvd, #400, Austin, TX 78759
Time:  Noon to 2 p.m.
RSVP:  February 27 by noon

RSVP to Juanita Hill at juanita_hill@bcbstx.com.


Medical Appointment Standards

Primary Care Providers (PCPs) and specialists must meet standards for appointment scheduling to help ensure that members have timely access to medical care and services. BCBSTX monitors provider compliance with appointment access standards on a regular basis. Failure to comply with outlined standards may result in corrective action. PCPs and specialists must make appointments for members from the time of request as follows:

Appointment Type

Standard

Emergency Care

Provided immediately when member presents or member is sent to the Emergency Center if deemed necessary and appropriate by the member’s PCP.

Urgent Care (not considered life threatening)

Care should be provided within 24 hours of the member’s appointment request.

Routine Sick Care

Appointment must take place within three (3) days for PCP and fourteen (14) calendar days of appointment request for Specialists.

Pre-Natal Care

Appointment must take place within fourteen (14) calendar days of appointment request, except for high-risk pregnancies or newly identified pregnant Members in her third trimester, in which case must be seen within five (5) days.  If an emergency situation exists, pre-natal members must be seen immediately.

Preventive Health Care (Adults)

Appointment must be offered to member within 90 days of request.

Preventive Health Care (Children)

Appointments must be offered in accordance with Texas Health Steps periodicity schedule and no later than 14 days after enrollment of a newborn or no later than 90 days of enrollment for members under the age of 21.

For more information regarding medical appointment standards, visit http://www.bcbstx.com/pdf/medicaid_star_chip_manual.pdf


Missed Appointment Tracking

When members miss appointments, providers must document the missed appointment in the member's medical record.  Providers must make at least three attempts to contact the member to determine the reason for the missed appointment. The medical record must reflect the reason any delays in performing an examination, including any refusals by the member.


Texas Health Steps Provider Outreach Referral Form

The Texas Health Steps Provider Outreach Referral Form should be used by all Texas Health Steps providers who submit a request for outreach on behalf of one of their Texas Health Steps patients as it replaces the Texas Health Steps Missed Appointment Referral Form. 
 
Texas Health Steps providers may use the referral form when submitting a request for outreach through the Texas Health Steps Provider Outreach Referral Service. This service, previously known as the Texas Health Steps Missed Appointment Referral Service, should be used when a Texas Health Steps patient needs to be seen for a follow-up, needs to have a missed appointment rescheduled, needs assistance scheduling transportation, or requires other patient-related outreach services. 

Texas Health Steps Provider Outreach Referral Form [Word 133KB] 
Texas Health Steps Provider Outreach Referral Form
[PDF 1.01MB] 

Instructions
[PDF 141KB] 


BCBSTX Provider File Updates

BCSTX members rely on the accuracy of the provider information in our online Provider Finder.  That is why it is so important that you inform BCBSTX of changes to your practice. Take a moment and verify your practice information located on our Provider Finder.


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.

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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 • February 2014 • www.bcbstx.com