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Blue Review - Blue Cross and Blue Shield of Texas

April 4, 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.


Oral Evaluation and Fluoride Varnish Benefits
Oral Evaluation and Fluoride Varnish (OEFV) benefits are provided as part of a Texas Health Steps Medical Check-up for members age 6 months through 35 months. OEFV benefits includes (during a visit) intermediate oral evaluation, fluoride varnish application, dental anticipatory guidance, and assistance with a Main Dental Home choice. 

  • OEFV is billed by Texas Health Steps Providers on the same day as the Texas Health Steps medical checkup.
  • OEFV must be billed concurrently with a Texas Health Steps medical checkup utilizing CPT code 99429 with modifier U5.
  • Documentation must include all components of the OEFV.
  • Texas Health Steps providers must assist members with establishing a Main Dental Home and document member's Main Dental Home choice in the member's file.
  • Providers must attend an OEFV training offered by the Department of State Health Services Oral Health Program to become certified to bill for this service.

For more information, visit the Texas Department of State Health Services Q&A on this topic.


Children of Migrant Farmworkers 

Children of Migrant Farmworkers due for a Texas Health Steps medical checkup can receive their periodic checkup on an accelerated basis prior to leaving the area. A checkup performed under this circumstance is an accelerated service, but should be billed as a checkup. Performing a make-up exam for a late Texas Health Steps medical checkup previously missed under the periodicity schedule is not considered an exception to periodicity or an accelerated service. It is considered a medical checkup.

The Migrant Farmworker Questionnaire (available in English and Spanish) is a tool to assist in identifying children of migrant farmworkers who may travel with parents for work. These children may qualify for accelerated services due to travel to other parts of the country.


Coordination of Benefits

When applicable, Blue Cross and Blue Shield of Texas (BCBSTX) coordinates benefits with any other carrier or program that the member may have for coverage, including Medicare. Indicate "Other Coverage" information on the appropriate claim form. If there is a need to coordinate benefits, include at least one of the following items from the other carrier or program when submitting a Coordination of Benefits (COB) claim:

  • Third-party Remittance Advice (RA)
  • Third-party letter explaining the denial of coverage or reimbursement

COB claims received without at least one of these items will be returned with a request to submit to the other carrier or program first. Please ensure that the information you submit explains any coding listed on the other carrier's RA or letter. We cannot process your claim without specific information. BCBSTX must receive COB claims within 95 days from the date on the other carrier's or program's RA or letter of denial of coverage. 


Texas Case Management Program for Medicaid Children and Pregnant Women

Case Management for Children and Pregnant Women is a Medicaid benefit. Through the program, case managers help families get medical services, school services, medical equipment and supplies and other services that are medically necessary.

Case managers can help children and young adults age 20 and younger who have a health condition or health risk who are covered by Medicaid. They also can help women of any age with a high risk pregnancy. The person or family must require help getting services or they must be having trouble finding or connecting with the services that they need related to their health condition or health risk.

Providers may contact the Texas Health Steps (THSteps) for a referral at 877-847-8377.  More information, including a video in English and Spanih, regarding the Texas Case Management Program for Children and Pregnant Women, can be found online.


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, 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 • April 2014 • www.bcbstx.com