A Medicaid Provider Newsletter
September 2017
Did You Know?HHSC Mandatory Training for FMSAs
Register today for the September 19 Texas Health and Human Service Commission (HHSC) Annual Financial Management Service Agency (FMSA) training. You may choose to attend in-person or via webinar. A link to register is included. Training is mandatory.
Read MoreIt’s Almost That Time of Year Again ... HEDIS® 2018
HEDIS audits provide important health plan data such as quality scores, rankings and accreditation status. Your participation and document preparation are very important.
Read MoreAction Required – TMHP Enrollment Requirements
STAR, STAR Kids and Children’s Health Insurance Program (CHIP)Beginning October 16, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer pay for any prescriptions written by providers who are not enrolled with Texas Medicaid & Healthcare Partnership (TMHP) for STAR members and STAR Kids; and beginning January 1, 2018, for CHIP members. This includes refills and prescriptions filled out-of-state. To ensure your patients continue receiving their medications, please visit the TMHP website.
Reminder: All LTSS Providers Must Complete MCO Enrollment by January 1, 2018
HHSC states that all long-term services and support (LTSS) providers assigned an API must complete the Managed Care Organization (MCO) LTSS provider enrollment process no later than January 1, 2018. Providers not enrolled by the deadline may be unenrolled from the MCO LTSS program. MCO LTSS providers must have submitted an enrollment application by July 1, 2017. Applications can be requested (as well as enrollment and application status) by emailing MCO_LTSS_Provider_Re-Enrollment@hhsc.state.tx.us. The request must include the provider’s business name, tax identification number and National Provider Identifier. Questions or concerns can also be sent to the same email address.
Claims & Eligibility
Physical, Occupational and Speech Therapy Benefits for All Ages to Change for Texas Medicaid September 1, 2017
Review a notification that describes changes to physical therapy, occupational therapy and speech therapy Medicaid benefits. These changes go into effect today, September 1.
Read MoreReminder: AAPCA Medicaid Benefits Transitioning to MCO
Individuals currently receiving Medicaid benefits through the Department of Family and Protective Services Adoption Assistance or Permanency Care Assistance (AAPCA) programs began receiving their Medicaid benefits through an MCO today, September 1.
Read MoreRecoupment of EVV Claims Without Valid EVV Transactions
STAR Kids Electronic Visit Verification (EVV)-related claims must include all required data elements. Claims submitted in the EVV system without the valid transaction data prior to receipt of claim payment will be recouped for dates of service including June 1, 2017, and after. For more information, resources are provided below.
- HHSC EVV Provider Information
- BCBSTX Provider Customer Service: 1-877-784-6802
- BCBSTX EVV mailbox for questions or concerns: BCBSTX_EVV_Questions@bcbstx.com
Education & Reference
STAR Kids, Coordination of Care and Texas Health Steps
Collaborating with STAR Kids Service Coordinators can improve the health outcomes of our shared members. We encourage you to reach out to a Service Coordinator if you have questions about a member, utilization or authorization needs. Also, encouraging preventive health exams amongst this population imparts education and anticipatory guidance in between preventive visits.
Read MoreWhat Can Be Done About Preventable ED Visits?
In a research study, it was concluded that some patients think Emergency Departments (ED) provide more convenient and better care than a physician’s office. Learn more about the results of the study and what you and your office staff can do to improve the overuse of hospital EDs.
Read MoreWebinars
If you are a newly contracted provider or an existing provider who needs a refresher on one of these subjects, consider attending the following webinars. Please RSVP by the deadline.
Note: If you’re not able to attend any of the trainings below, they are available for completion via Brainshark at your own pace, date and time.
LTSS STAR Kids Provider Training
Septmeber 14, 2017
Noon – 1:30 p.m.
RSVP deadline: Septmeber 12 by noon
Current News and Updates
Septmeber 21, 2017
Noon – 1:30 p.m.
RSVP deadline: Septmeber 19 by noon
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 (TMHP) 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 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 Consuelo 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.