A Medicaid Provider Newsletter
December 2017
Hot TopicsMCO Enrollment Application Due by Jan. 1 for All LTSS Providers
Long Term Services and Supports (LTSS) providers serving managed care members (MCO LTSS providers) are required to enroll through the Medicaid Managed Care Organization LTSS provider enrollment process no later than January 1, 2018. To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible. Please reference the Q&A document and the provider Enrollment Crosswalk, which identifies the enrollment method for various provider types and Department of Aging and Disability Services contract types. MCO LTSS providers may obtain an application by submitting a request to 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 may also be submitted to this same email box; please copy your Health Plan Management team.
Childhood Immunization Status (CIS) for HEDIS® 2018
Review information on how to have a successful CIS Healthcare Effectiveness Data and Information Set (HEDIS) audit, including vaccine requirements and common errors made regarding CIS.
Read MoreSTAR Kids Added as Line of Business to HEDIS 2018
Review the measures being audited for STAR Kids during the 2018 HEDIS.
Read MoreNetwork Participation
TMHP Enrollment Due by December 31 to Continue Receiving 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 (MCO) to complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017. 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.
Claims & Eligibility
835 Electronic Remittance Advice (835 ERA) Update
Effective November 30, 2017, government programs providers enrolled to receive the 835 ERA from Blue Cross and Blue Shield of Texas (BCBSTX) may request redelivery of missing ERA files to their designated receivers issued since January 1, 2017. Please note that ERA files originally issued prior to January 1, 2017, cannot be reloaded.
Read MoreEducation & Reference
2017-2018 Flu Season Is Upon Us
It’s been predicted by the WHO that the 2017-2018 flu season could be severe. As you know, the influenza vaccine is the best defense to prevent flu. Be sure to educate your patients and staff with updated “flu facts” and have an ample supply of effective vaccines to prepare for this year’s flu season.
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.
Provider Enrollment, Plus News and Updates
December 14, 2017
Noon – 1:30 p.m.
RSVP deadline: December 12 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’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.