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Blue Review - Blue Cross and Blue Shield of Texas

July 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.


Obstetric Delivery Enhanced Claims Requirement Updates
BCBSTX has enhanced claims requirements related to Obstetric Delivery claims, including unbundling delivery and postpartum procedure codes. We will also update diagnosis code requirements for medically necessary early elective deliveries. Providers will need to modify the way they bill for delivery and postpartum claims, as well as medically necessary deliveries prior to 39 weeks of gestation. These changes apply to Medicaid (STAR) providers.

Currently the delivery and postpartum services are bundled, which limits reimbursement and the ability to report HEDIS quality outcomes for postpartum care. BCBSTX will continue to allow one postpartum visit. As of May 1, 2014, BCBSTX requires the delivery and postpartum services to be billed unbundled.

Acceptable unbundled codes:


Procedure Code

Code Description

59409
59612

Vaginal Delivery Only

59514
59620

C-section  Delivery Only

59430

Postpartum Outpatient Visit

 

 

 

 

 


Medically Necessary Deliveries

For medically necessary deliveries prior to 39 weeks of gestation, Modifiers U1 - U3 are required on the claim in compliance with Texas Medicaid:  59409, 59514, 59612 and 59620. Failure to bill with a "U" modifier will cause the claim to be denied. Procedure codes 59410, 59614, 59515 and 59622 will no longer be separately reimbursable as these are bundled codes. Claims with these procedures will be denied. 

Modifier

Modifier Description

U1

Medically necessary delivery prior to 39 weeks of gestation

U2

Delivery at 39 weeks of gestation or later

U3

Non medically necessary delivery prior to 39 weeks of gestation

 

 

 

For all claims submitted with the U1 modifier and designated as a medically necessary delivery prior to 39 weeks of gestation, we will require diagnosis codes to support medical necessity.  Any claim with procedure codes 59409, 59514, 59612 and 59620, and the "U1" modifier that are billed without one of the required medically necessity diagnosis (any position) will be denied.  Providers may appeal the claim with medical records.

Here are the Modifier U2 medically necessary diagnosis codes.

Additional claims information

  • Claims billed with the bundled delivery codes 59410, 59515, 59614 and 59622 will be denied.
  • Corrected claims can be submitted within 120 days from the Explanation of Payment date for payment with the unbundled procedures.
  • Global delivery codes (59400, 59510, 59610, 59618) will continue to not be reimbursable.
  • You can find more information on our appeal process in our provider manual.

Upcoming Provider Training

Topic: OB/GYN Claims and Billing
Date:   July 11, 2014
Place:  Marie Callender’s, 9503 Research Blvd., #400, Austin, TX 78759
Time:   Noon to 2 p.m.
RSVP: July 10 by noon
Soup & salad bar lunch will be served

Topic:  Claims and Billing
Date:   July 25, 2014 
Place:  Red Lobster, 3815 S. Lamar Blvd, Austin, TX 78704
Time:   Noon to 2 p.m.
RSVP:  July 24 by noon
Lunch will be served

Topic:  Migrant Adolescent Health
Date:   July 30, 2014 
Place:  Joe's Crab Shack, 600 E. Riverside Dr. Austin, TX 78704
Time:   Noon to 2 p.m.
RSVP:  July 29 by noon
Lunch will be served

RSVP to Juanita Hill at Juanita_Hill@bcbstx.com


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. 


Help Medicaid Patients Keep Appointments with Free Rides

If your Medicaid patients have trouble keeping his or her appointment with your office because they lack transportation or gas money, let the patient know how to seek help from Medicaid.

Medicaid patients who need a ride to a doctor's office - or dentist office, hospital, drug store or any place they receive Medicaid services – may call for a ride toll free. 

BCBSTX Medicaid (STAR) members may call the state Medical Transportation Program (MTP) at 877-MED-TRIP (877-633-8747).

BCBSTX offers Medical Transportation as a value added service to BCBSTX CHIP members. Medicaid (STAR) members who are having difficulty obtaining non-emergency transportation from MTP can arrange for transportation from BCBSTX. Members may call the BCBSTX Customer Care Center at 888-292-4480. 


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

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.

 



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contact the vendor directly.

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Blue Review Medicaid (STAR) & CHIP UPDATE • July 2014 • www.bcbstx.com