July 2017

THSteps Therapeutic Dental Benefits Changes

Review the four new changes to the Texas Health Steps (THSteps) therapeutic dental benefits, as well as the prior authorization for Level 4 deep sedation and general anesthesia that went into effect on July 1.

Reminder: Address Changes for Claims, Appeals and Overpayment Recovery Requests

The address for claims and appeals submissions changed on December 31, 2015. The overpayment recovery address changed on June, 1, 2017.

Update Regarding Claim Denials for Discharge Status

Blue Cross and Blue Shield of Texas Medicaid (STAR) CHIP and STAR Kids is updating prior notices sent on February 24, 2017. Clean claims submitted with discharge status code 01 and frequency code 1 will be processed. Claims submitted with discharge status code 30, and frequency code 5 or 7 will be denied. Please review the Texas Medicaid and Health Partnership (TMHP) manual for more information on submitting the most appropriate frequency codes.

AAPCA Medicaid Benefits Transitioning to Managed Care

Beginning September 1, 2017, individuals currently receiving Medicaid benefits through the Department of Family and Protective Services Adoption Assistance or Permanency Care Assistance (AAPCA) programs will receive their Medicaid benefits through an MCO. MCO means that Medicaid beneficiaries receive their health benefits through a health plan’s network of doctors, specialists and other providers. Medicaid benefits will not change. Medicaid will continue covering doctor’s visits, hospital visits, therapies, specialists, medical equipment and medical supplies. Most AAPCA clients will go into the STAR MCO program. Beneficiaries who receive Supplemental Security Income and/or Medicare will go into the STAR Kids MCO program. AAPCA beneficiaries who receive services through a 1915(c) waiver already transitioned to STAR Kids on November 1, 2016. To learn more, go to hhs.texas.gov/AAPCA.

TMHP Enrollment Due by December 31 to Continue Receiving Reimbursements for CHIP Services

Medicaid providers who currently render services to Children’s Health Insurance Program (CHIP) members through an MCO must complete enrollment with the TMHP by December 31, 2017.

Enrollment Information Specific to CHIP Providers

During enrollment, providers can now specify that they intend to only serve CHIP members on the enrollment application. It is recommended that providers begin the enrollment process as soon as possible.

The Obesity Epidemic and the CDC’s 6/18 Initiative

Check out the Centers for Disease Control and Prevention (CDC) 6/18 Initiative that highlights the six health conditions that yield the highest costs. Several of the conditions can be associated with being overweight or obese. To help members improve their health, counseling and referrals need to take place in their medical home by their primary care physician.

Prenatal and Postpartum Care Effects on Population

To help improve the infant mortality rate, and the care and safety of pregnant women, review the state requirements for high-risk and third trimester patients. Also, to ensure HEDIS^® compliance, review the requirements for prenatal and post-natal checkups.

Guiding Your Patients with Anticipatory Guidance

Guidance about age-specific healthy behaviors, growth and development, discipline and other topics educates patients and caregivers for the time in between their well visits. Also, ensuring they have your after-hours information is important for decreasing PPVs.

Hearing Our Members and Striving Toward Excellence

Review our 2014 to 2016 Consumer Assessment of Healthcare Providers and Systems member survey results. The specific questions were focused on care received from you, our valued providers.

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.