A Medicaid Provider Newsletter
May 2017
Texas Health Steps (THSteps) Training
On May 10, Blue Cross and Blue Shield of Texas (BCBSTX) is hosting a training for primary care physicians, FQHC and RHC practitioners that will provide an overview of the THSteps program. The facilitator is Deneice Pryor, and lunch will be provided.
Date: May 10, 2017
Time: Noon – 2:30 p.m.
Location: BCBSTX, 9442 Capital of TX Hwy N, Plaza II, Suite 500, Austin TX 78759
RSVP deadline: May 8 by noon
Network Participation
Language Barrier in Health Care
As a reminder, state law requires after-hour messaging and/or answering services to offer Spanish language services. BCBSTX monitors this language component during our quarterly audits.
Read MoreClaims & Eligibility
Changes 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 MoreAddress Changes for Claims, Appeals and Overpayment Recovery Requests
The address for claims and appeals submissions changed on Dec. 31, 2015. The overpayment recovery address will be changing on June, 1, 2017.
Read MoreEducation & Reference
The Importance of Documentation: If it Wasn’t Documented, It Wasn’t Done
Did you know that “missing documentation is the largest factor and the primary cause of records being reviewed and money being recouped”? Access a letter published by HHSC that details six components that must be documented in medical records to receive reimbursement.
Read MoreThe Obesity Epidemic
Because of the obesity epidemic in the U.S., we encourage you to discuss how to improve nutrition with your patients. Emphasizing the importance of simple food and lifestyle changes can have big impacts. Also, remember to document your patient education for nutrition counseling and physical activity in your medical records.
Read MoreClinical Resources
2016-17 RSV Season Ended April 14
The 2016-17 Respiratory Syncytial Virus (RSV) season ended on April 14 for all counties in Texas. There were no extensions for HHS regions this season based on recommendations from the Texas Pediatric Society RSV Task Force. Coverage of Synagis (palivizumab) has ended for people enrolled in Medicaid (both traditional and managed care) and the CSHCN Services program. In addition, pharmacy claims and prior authorization requests won't be accepted or reviewed after April 14, 2017.
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.
Medicaid Managed Care Comprehensive Overview Webinar
Purpose: Orientation for newly contracted providers and a refresher for existing providers
Audience: PCP, Specialists, FQHC/RHC, Hospital Staff
May 10, 2017
Noon – 1:30 pm
RSVP deadline: May 8 by noon
STAR Kids Provider Training – Webinar
Purpose: Orientation for newly contracted providers and refresher for existing providers
Audience: PCPs, Specialists, FQHC/RHC
May 17, 2017
Noon – 1:30 pm
RSVP deadline: May 15 by noon
LTSS STAR Kids Provider – Webinar
Purpose: Orientation for newly contracted providers and a refresher for existing providers
Audience: DME, Home Health, LTSS service providers
May 24, 2017
Noon – 1:30 pm
RSVP deadline: May 22 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 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.