Blue Review
A Medicaid Provider Newsletter

March 2018

Hot Topics

Mandatory Training: Financial Management Services Agency (FMSA) Webinar

All currently contracted FMSAs who work with a Managed Care Organization (MCO) must attend a mandatory webinar on Tuesday, March 6. The training is a condensed version of the Texas Department of Health and Human Services Commission’s (HHSC) FMSA enrollment training. A registration link is provided.

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Reminder: The HEDIS® 2018 Season Is Upon Us

Review the HEDIS HYBRID 2018 measures that are up for performance review. Also, some measures require information directly from patient medical records that are kept at the physician’s office. As such, we may contact your office with a list of patients whose medical records need to be reviewed. If your office uses a third-party vendor for medical records, please notify us immediately so steps can be taken to obtain the necessary records in a timely manner.

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Featured Tip

Keep Your Information Updated to Receive Quick and Accurate Payments

To provide the best service to you and your patients, it's very important that all the information Blue Cross and Blue Shield of Texas (BCBSTX) has about your practice is current and accurate. Be sure to let us know about any changes to your practice address, email and/or physician rosters. Keeping us informed of any changes to your information helps us pay your claims more quickly and accurately. It also makes it easier for your patients to get current and correct information on our Provider Finder®. You can update your information by completing the Demographic Change form.

Network Participation

Required Medical Appointment Standards

Review appointment standards for general appointment scheduling, services for members under age 21 and over age 21. Failure to comply with outlined standards may result in corrective action.

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Clinical Resources

Stay in Compliance with Private Duty Nursing (PDN) Requirements

Make sure you’re up to date on the new STAR Kids requirements for PDN.

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Language Barriers Adding to Health Disparity in America

The HHSC has a contract in place for you to use two Spanish translation vendors; information on how to do so is included. Also, your office should have quality improvement strategies in place to ensure the competency of the interpreters, translators and bilingual staff who provide direct health care services in languages other than English.

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Claims & Eligibility

Zika Prevention Member Benefit

As of Feb. 12, 2018, mosquito repellent for the prevention of Zika became a continuous benefit for BCBSTX’s Children’s Health Insurance Program members. MCOs should have already begun adjudicating claims on that date. Read on for benefit details and what non-compliant MCOs should do in the interim.

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Education & Reference

Essential Aspects of Texas Health Steps (THSteps) and Well-child Exams

Review the required components that must be done during all THSteps and well-child exams.

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Flu Epidemic Notification from the CDC

Given the severity of this year’s flu season, it’s important that your patients have timely access to your office if they’re experiencing flu symptoms. Continue recommending the flu vaccine for everyone ages 6 months and older, and educating your patients about flu prevention.

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Health & Wellness

New! Health Tips to Share

Help your patients live a healthier life by sharing relevant wellness information with them. You can print individual articles, or point your patients to the websites so they can review topics that interest them. Anyone can access the websites; no login required.

LifeTimesBCBSTX’s LifeTimes website has many articles on a range of topics including: bone and joint health, cancer, diabetes, general health, and heart and lung health. Spanish content is available.

ConnectConnect invites users to get answers, share information and gain knowledge on topics like well-being and health coverage through blogs, videos and downloadable content. Participants can create a profile and like posts, add their opinions in the comments and subscribe to content they’re interested in. Spanish content is available.


If you are a newly contracted provider or an existing provider who needs a refresher on topics related to Texas Medicaid, please consider attending one of our weekly webinars.

Provider training with the Texas Medicaid Network Department will occur every Friday from 12:30 – 2 p.m. CT. The topics for these trainings will vary and meeting details will be updated and posted on BCBSTX’s Medicaid provider website.

Request Meeting Topics!
Please email the Texas Medicaid Network Department to request training topics!

Meeting Information
Join the WebEx meeting:
Meeting number: 626 749 977

Join by phone:
Toll-free: 1-877-249-5777

If you are unable to attend our training sessions, they are available for completion via Brainshark® at your own pace, date and time.

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 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: 1-877-560-8055, Monday - Friday, 8 a.m. - 8 p.m. CT
STAR Kids Customer Service: 1-877-784-6802, Monday - Friday, 8 a.m. - 8 p.m. CT

For general questions and concerns:
Phone: 1-855-212-1615
Fax: 1-512-349-4848

For member outreach inquiries, BCBSTX’s Medicaid (STAR), STAR Kids and CHIP members may contact Zenaida Martinez Nava, Senior Outreach Specialist/Member Advocate at 1-512-349-4880. If the member is unable to reach Sonia, please contact Maria Izquierdo at 1-512-349-4887.

For BCBSTX Medicaid (STAR), STAR Kids and CHIP quality inquiries, please contact Kathleen Thompson, Manager Medicaid Quality, at 1-512-349-4836.

For Electronic Visit Verification questions, please email