August 2018

Learn the Benefits of Case Management and How to Make a Referral

Case Management (CM) is a collaborative process that assesses, develops, coordinates, monitors and evaluates care plans designed to optimize members’ health care benefits and promote quality outcomes. Our CM nurses work directly with our members who are your patients to accomplish these endeavors. Physicians and other professional providers, such as nurses and social workers, may refer members for CM. Members (or their representatives) may also self-refer themselves.

The process of referring members to CM is noted below.

Members enrolled in the following BCBSTX plans:

• STAR
• CHIP
• STAR KIDS

CM is an optional program in which case managers assist members with navigating health care services and coordination of care with providers. Members enrolled in CM develop a member-centric care plan with their case manager that focuses on health care goals. Providers will soon be able to view this care plan through the provider portal (coming soon), and call a member’s case manager to obtain a written copy of the care plan.

1. Send an email with the following information to STAR_Kids­­­_HC@bcbstx.com:
• Member’s name and date of birth
• Member ID (if available)
• Referral reason
• Medical diagnoses and any pertinent medical information
• Any urgent needs
2. The physician should request a follow up from CM for the member.
• Members will receive outreach from CM within two weeks.
• If a member has any urgent needs, the provider should indicate that in the email, and CM will reach out sooner.
• Physicians who would like CM to follow up with them, must indicate the follow up in their request.

Note: This is not the process for requesting an acute authorization.