Blue Review
A Medicaid Provider Newsletter

January 2018

Hot Topics

The HEDIS® 2018 Season Is Upon Us

Review the HEDIS HYBRID 2018 measures that are up for performance review. Also, some measures require information directly from patient medical records that are kept at the physician’s office. As such, we may contact your office with a list of patients whose medical records need to be reviewed. If your office uses a third-party vendor for medical records, please notify us immediately so that steps can be taken to obtain the necessary records in a timely manner.

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Network Participation

Reimbursements for CHIP Services

The Texas Health and Human Services Commission (HHSC) requires providers who currently render services to Children's Health Insurance Program (CHIP) members through a Managed Care Organization to complete enrollment with the Texas Medicaid & Healthcare Partnership. Providers can designate in their enrollment applications that they intend to serve only CHIP members. CHIP providers are encouraged to enroll using the Provider Enrollment on the Portal. While the enrollment process and application are the same for Medicaid and CHIP providers, CHIP-only providers are not required to participate in Texas Medicaid. CHIP-only providers must follow these instructions to indicate they only intend to serve CHIP members and to ensure that they do not appear on the Medicaid online provider lookup.

Education & Reference

Free Value Added Services Cover Preventive Care

Review some programs and services that are covered by BCBSTX for STAR, STAR Kids and CHIP members (that are not covered by Medicaid or CHIP).

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Texas Health Steps (THSteps) Procedures and Documentation Reminder

This is a reminder to give immunizations and lab tests during checkups according to the THSteps periodicity schedule. Review the six THSteps checkup components.

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Clinical Resources

Private Duty Nursing Policy Language Clarification

The HHSC has posted a provider notification regarding minor language clarifications to the TXHealthSteps-CCP Private Duty Nursing policy, effective January 1, 2018. This clarification explains that additional prior authorization documentation may be requested for initial requests, recertifications and revisions. This additional documentation may include, but is not limited to, nurse notes, medication administration records, seizure logs, and/or ventilator logs.

Webinars

If you are a newly contracted provider or an existing provider who needs a refresher on topics related to Texas Medicaid, please consider attending one of our weekly webinars.

Provider training with the Texas Medicaid Network Department team will occur every Friday from 12:30 – 2 p.m. CT. The topics for these trainings will vary and meeting details will be updated and posted on the BCBSTX Medicaid provider website.

Request Meeting Topics!
Please email the Texas Medicaid Network Department to request training topics!

Meeting Information
Join the WebEx meeting: hcsc.webex.com
Meeting number: 626 749 977

Join by phone:
Toll-free: 1-877-249-5777
Meeting ID: 626 749 977

If you are unable to attend our training sessions, they are available for completion via Brainshark at your own pace, date and time.

Have You Updated Your Provider Information?

Visit the BCBSTX provider website to update any changes to your address, telephone number, group affiliation, and/or any other material facts via the Provider Data Update Notification form. Also, update your information with Texas Medicaid & Healthcare Partnership via their Provider Information Change form.

News & Updates

For the most up-to-date information, view the News & Updates section of the BCBSTX provider website.

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.

Contact Us

Eligibility, Benefits, Provider Network Referrals and Claim Status
Medicaid (STAR) and CHIP Customer Service: 877-560-8055, Monday - Friday, 8 a.m. - 8 p.m. CT
STAR Kids Customer Service: 877-784-6802, Monday - Friday, 8 a.m. - 8 p.m. CT

For general questions and concerns:
Email: TexasMedicaidNetworkDepartment@bcbstx.com
Phone: 855-212-1615
Fax: 512-349-4848

For member outreach inquiries, BCBSTX’s Medicaid (STAR), STAR Kids and CHIP members may contact Sonia Saenz, Senior Outreach Specialist/Member Advocate at 512-349-4883. If the member is unable to reach Sonia, please contact Maria Izquierdo at 512-349-4887.

For BCBSTX Medicaid (STAR), STAR Kids and CHIP quality inquiries, please contact Kathleen Thompson, Manager Medicaid Quality, at 512-349-4836.