Blue Review
A Medicaid Provider Newsletter

October 2017

Did You Know?

HHSC Notice: Prescriber Enrollment Project Cancelled; No Longer Applies to Managed Care Out-of-network Providers

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.

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Hot Topics

Reminder: It’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.

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Network Participation

After-hours Service Requirements

As 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.

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Claims & Eligibility

Increased Access to Breast Pumps Effective September 1, 2017

Texas 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.

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Education & Reference

U.S. Teens Need Your Help; October is National Depression Education and Awareness Month

Sadly, 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.

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Raise Patient Awareness About Women’s Cardiovascular Health

With 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.

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Use Your Influence to Fight Childhood Obesity

Common 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.

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Webinars

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.

OB/GYN

October 12, 2017
Noon – 1:30 p.m.
RSVP deadline: October 10 by noon

RSVP

STAR, CHIP, STAR Kids Comprehensive Overview

October 19, 2017
Noon – 1:30 p.m.
RSVP deadline: October 17 by noon

RSVP

LTSS STAR Kids

October 26, 2017
Noon – 1:30 p.m.
RSVP deadline: October 24 by noon

RSVP

STAR Kids

November 2, 2017
Noon – 1:30 p.m.
RSVP deadline: October 31 by noon

RSVP

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.