December 2018
Hot Topics
2019 Preauthorization Information Updates
The 2019 Preauthorization Grid, 2019 Preauthorization List and the 2019 Preauthorization Summary of Changes have been posted on Blue Cross and Blue Shield of Texas’ (BCBSTX) Clinical Resources page. Please access these files before Jan. 1, 2019, so you are familiar with the changes. If you have any questions, please contact BCBSTX’s Medicaid Network Department at TexasMedicaidNetworkDepartment@bcbstx.com or call 1-855-212-1615.
Availability of Utilization Management Criteria
BCBSTX will provide Utilization Management criteria to providers upon request and in denial notifications. The criteria will be mailed, faxed or emailed. To receive a copy, call BCBSTX at:
- 1-877-560-8055 for STAR or CHIP members
- 1-877-784-6802 for STAR Kids members
Medical Policies: We Want Your Feedback
Learn how to view medical policies – even those that are pending – and how to provide your comments about those policies. We welcome your feedback.
Read MoreDo You Have a Therapy Patient Waitlist or Aren’t Accepting New Therapy Patients?
Please notify BCBSTX if you’re a therapy provider who has a waitlist or if you’re no longer accepting new patients.
Read MoreElectronic Visit Verification (EVV) Updates
HHSC Notifications
The Texas Health and Human Services Commission (HHSC) has released new notices about EVV that you need to be aware of. Please read the most recent EVV updates, which can be found on BCBSTX’s provider site.
Featured Tip
Reminder – How to Keep the Cash Flowing: Billing BCBSTX Medicaid as a Secondary Insurance
Review the ins and outs of billing BCBSTX as secondary for Medicaid claims. To keep the cash flowing, it’s important to remember that if a commercial payer exists, Medicaid is always the payer of last resort.
Read MoreEducation & Reference
Free Training and Support for Cultural Competence
BCBSTX is committed to providing culturally competent care by offering free training and support to providers and their staff. As a requirement for the Medicaid program, we have added a Cultural Competency training indicator to our provider directories.
Read MoreBe Prepared for this Year’s Influenza Season
Review the Advisory Committee on Immunization Practices’ recommendations regarding seasonal influenza vaccines in the U.S. Also, continue educating your patients and staff on the importance of the influenza vaccine for themselves and family members.
Read MoreFocus on Behavioral Health
Behavioral Health Resources for School-aged Children
The number of kids ages 5 to 17 hospitalized for suicidal thoughts or suicide attempts has more than doubled in the past 10 years. Take advantage of the resources available to help you provide mental health screenings and treatment for your patients.
Read MoreHealth & Wellness
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.
Connect 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.
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 and Updates
For the most up-to-date information, view the News and 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:
Email: TexasMedicaidNetworkDepartment@bcbstx.com
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, Director, Quality Improvement, at 1-512-349-4836.
For Electronic Visit Verification questions, please email BCBSTX_EVV_Questions@bcbstx.com.