The CMS says that 42 CFR 455.410(b) is not applicable to out-of-network providers servicing managed care clients. However, 42 CFR 455.410(b) is applicable for providers servicing traditional Medicaid clients.
Read MoreHEDIS audits provide important health plan data such as quality scores, rankings and accreditation status. Your participation and document preparation are very important.
Read MoreAs a Blue Cross and Blue Shield of Texas provider, certain requirements must be met for after-hours services. Make sure you’re aware of these requirements, as well as contract standards, unacceptable after-hours coverage and language-appropriate services.
Read MoreTexas Medicaid has developed additional medical necessity criteria to improve access to breast pump equipment for breastfeeding mothers and their infants. This improved coverage for breast pumps is intended to enhance the opportunities for providers to support the mother’s and infant’s breastfeeding efforts. Additional information is available in this Texas Medicaid & Healthcare Partnership fact sheet.
Read MoreSadly, the rate of teen suicide has increased 40 percent over the last 10 years. As such, a key component of Texas Health Steps is psychosocial/behavioral health screenings. These screenings play a key role in the fight against depression and teen suicide.
Read MoreWith heart disease and stroke being the No. 1 and No. 4 killers of U.S. women, it’s important to inform your patients about the behaviors they can control to help lower their risk of experiencing these diseases.
Read MoreCommon diseases now affecting U.S. children include Type 2 diabetes, hypertension and heart disease. As a provider, you have tremendous influence with your younger patients, so offer lifestyle suggestions that can help make a difference in their overall health and wellness.
Read MoreIf 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.
October 19, 2017
Noon – 1:30 p.m.
RSVP deadline: October 17 by noon
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.
For the most up-to-date information, view the News & Updates section of the BCBSTX provider website.
On this website, you will find links to the provider manual, Quick Reference Guide, services requiring prior authorization and other useful information.
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.