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Blue Review - Blue Cross and Blue Shield of Texas

News Alert: June 27, 2014

Attention: BCBSTX Medicaid (STAR) and CHIP Providers

Claim System Issue

BCBSTX Medicaid (STAR) and CHIP wants to make you aware of a claim submission system error we are currently experiencing. The system error is causing some claims to reject erroneously. Providers who are impacted by this system issue are receiving a mail-back form titled:

****IMPORTANT NOTICE****
MISSING/INVALID INFORMATION
CMS-1500, UB or DENTAL CLAIM FORM

The form states we are unable to process the claim. The reasons listed may include:
079 Member not found,
019 Invalid Diagnosis Code Pointer

We are diligently working to resolve this issue as quickly as possible.

Provider Actions

If you receive the above referenced mail-back form, please follow the steps below.

  1. Verify patient was eligible with BCBSTX Medicaid (STAR) and CHIP on the DOS and that you are using the correct diagnosis code pointers (A, B, C, etc.).
  2. Print a revised CMS-1500 (02/12) form for each patient you receive a mail-back form and have identified the rejection was in error.
  3. Contact your local network representative. Contact information is listed at the end of this bulletin.

BCBSTX Medicaid (STAR) and CHIP Actions

Once your BCBSTX network representative receives notification from you that you were impacted by the system issue and have printed the claims, the network representative will:

  1. Provide you with a special mailing address to mail the claims to their attention.
  2. Facilitate the processing of the claims to bypass the system issue.

As we get more information on this issue and its impact or resolution, we will immediately notify you via subsequent bulletins. If you have any additional questions or concerns, please contact your local network representative.

BCBSTX Medicaid (STAR) and CHIP
512-349-4896

Network Provider Representatives Service Territories & Contact Information

Professional Provider Network

Dee Culver, deanna_culver@bcbstx.com, 512-349-4899
Burnet, Lampasas, Llano, San Saba, Travis, Williamson (except Georgetown & Round Rock)

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

 



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