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Blue Review - Blue Cross and Blue Shield of Texas

March 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: Texas Health Steps Training
Presenter: Deneice Pryor, RN, BSN; Provider Representative for Texas Health Steps
Date: March 11, 2014
Place: Marie Callender's, 9503 Research Blvd, #400, Austin, TX 78759
Time: Noon to 2 p.m.
RSVP: March 10 by noon

Topic: Provider Comprehensive Overview
Date: March 27, 2014
Place: Blue Cross and Blue Shield of Texas; 9442 Capital of Texas Highway North, Suite 500, Arboretum Plaza II, Austin, TX 78759
Time: Noon to 2 p.m.
RSVP: March 26 by noon

Special Evaluation Coding Change

Effective Jan. 1, 2014, CPT®’ Code 92506 (Evaluation of Speech) was terminated and has been replaced with four new codes designed to more specifically evaluate language, fluency, voice and speech disorders.

The new codes are:
  • 92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
  • 92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
  • 92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
  • 92524 Behavioral and qualitative analysis of voice and resonance
These new codes are in effect for dates of service on or after Jan. 1, 2014. Please note that claims submitted using code 92506 with dates of service for Jan. 1, 2014, and after will be denied. For services provided on or after Jan. 1, 2014, we will continue to pay the rate associated with code 92506 for the new 2014 codes until we receive updated rate information from the state, at which time we will adjust the rate accordingly which may result in request for refunds.

For additional information about the coding change, visit the website of the American Speech-Hearing Association (ASHA) at www.asha.org.

NDC Billing Requirements for Provider Administered Drugs

A Provider Administered Drug is defined by the Health and Human Services Commission as a paid medical benefit in an outpatient setting. In addition to drugs, long-acting, reversible contraceptives such as intrauterine devices (IUDs), hormone patches, vaginal rings, sub dermal implants and intrauterine copper devices are included. All of the above would require a National Drug Code (NDC). If a claim is missing the NDC information or the NDC is not valid for the corresponding HCPSC code, BCBSTX will deny or reject the entire claim. An NDC is a unique 11-digit, three-segment number assigned to drugs by the U.S. Food and Drug Administration (FDA).

The NDC requirement affects primary care providers, specialty care providers, outpatient hospital departments and all other providers administering drugs to patients in an outpatient setting.

Exceptions to the NDC billing requirement are vaccines provided through the Vaccine For Children (VFC) program, durable medical equipment (DME), Limited Home Health Supplies (LHHS), and radiopharmaceuticals.

For additional information on billing, view the How to Submit Claims for Provider Administered Drugs located at http://www.bcbstx.com/provider/medicaid/claims.html, Related Resources.

Physician’s Orders for Vitamins and Minerals

BCBSTX Medicaid (STAR) and CHIP network pharmacies may honor a physician’s prescription for covered vitamins and minerals. To help expedite pharmacy claim processing, prescribing providers are encouraged to include the diagnosis on the prescription.

The attached table shows the vitamins and minerals that can be supplied through network pharmacies and the conditions that the vitamins or minerals are generally prescribed to treat.

2014 Immunization Schedule Now Available

The Recommended Childhood and Adolescent Immunization Schedule for 2014 is now available on http://www.tmhp.com/Pages/Medicaid/Medicaid_THSteps_Program_Info.aspx.

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 • March 2014 • www.bcbstx.com