A Medicaid Provider Newsletter
April 2017
Upcoming Provider Training Webinars
You are invited to participate in upcoming provider training webinars. Our webinars/trainings provide information and resources to fully engage our provider community. The schedule is below, and we ask that you 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.
AvailityTM Medicaid Training
April 11, 2017
Two sessions available:
10 – 11:30 a.m.
2 – 3:30 p.m.
RSVP deadline: April 10 by noon
STAR Kids – Long-term Services and Support/Electronic Visit Verification Webinar
April 14, 2017
Noon – 1:30 p.m.
RSVP deadline: April 12 by noon
Medicaid STAR, STAR Kids and CHIP: OBGyn Training
April 18, 2017
Noon – 1:30 p.m.
RSVP deadline: April 14 by noon
Network Participation
CHIP Participation in Central Texas
Blue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity to participate as a CHIP provider in the Medicaid Rural Service Area (MRSA) Central Texas. Find more information about participation on the BCBSTX provider website.
Language, Appointment Availability and After-hours Awareness
As a reminder, contracting with BCBSTX requires certain availability, after-hours access and a phone language component for our shared members/patients. Please be aware of these standards and educate your staff on these requirements.
Read MoreClaims & Eligibility
Attending Physician Taxonomy Numbers Are Not Required on Inpatient Claims
Requirements have changed for inpatient institutional claims; attending physician taxonomy numbers are no longer needed.
Read MoreChanges in Therapy Reimbursement Effective April 1, 2017
Blue Cross and Blue Shield of Texas (BCBSTX) implemented reimbursement rate changes on April 1 that affect STAR, STAR Kids and CHIP programs.
Read MoreChanges in Prior Authorization Process Effective June 1, 2017
Beginning June 1, eviCoreTM healthcare will provide prior authorization for expanded outpatient and specialty utilization management for BCBSTX Medicaid members. Review the specialized clinical services eviCore will manage.
Read MoreTexas Health Steps (THSteps)
Online Provider Education Opportunities
Check out the two new quick courses available through THSteps: A Prescriber’s Guide to Texas Medicaid Pharmacy Prior Authorization, and Teenage Confidential: Health Consent and privacy for Adolescents. Quick courses are five-minute targeted instruction on timely topics or policy updates.
Read MoreBridging the Gap: Culturally Effective Health Care
Being culturally aware of the differences among your patients will help bridge gaps in trust and create the best health outcomes. Check out THSteps’ Continuing Education Unit: Culturally Effective Health Care.
Read MorePeriodicity Schedule Update and Online Resources
Check out available resources from the Texas Department of State Health Services and THSteps, including the periodicity schedule, continuing education units, forms, requirements and more.
Read MoreFree Online Continuing Education Courses from the Department of State Health Services
THSteps’ award-winning online program offers free continuing education courses for primary care providers and other health professionals. These courses offer updated clinical, regulatory and best practice guidelines for a range of preventive health, oral health, mental health and case management topics.
Provider Outreach Referral Form
As a reminder, the THS Provider Outreach Referral form should be used by all THSteps providers who submit a referral on behalf of aTHSteps patient who needs assistance with:
- Scheduling a follow-up appointment
- Rescheduling a missed appointment
- Scheduling transportation to an appointment
- Other outreach services
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.
eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSTX.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.