November 2018
Hot Topics
VDP Notices for Makena and Brand EpiPen Shortages
The Texas Vendor Drug Program (VDP) has approved generics to address shortages of Makena® Vials and Makena Auto Injectors. Additionally, there is also an intermittent shortage of brand EpiPen®, brand EpiPen Jr. and their authorized generics. Please review the VDP notices and their approved generics. Questions about these notices can be directed to vdp_formulary@hhsc.state.tx.us. For the latest news and resources, please visit the Texas VDP website.
Alert! Texas Credentialing Verification Organization
Texas Medicaid Managed Care Organizations (MCOs) have become aware of a recent communication offering to help providers through the credentialing process for a $250 fee. The Credentials Verification Organization process is free to providers. Neither Medicaid MCOs, Aperture® or Availity® charge fees to become a credentialed provider. Read more about the CVO alert.
Tip Sheet for Understanding the PLB Segment on the 835 Electronic Remittance Advice (ERA)
Reversals and corrections may occur when claim adjudication results have been modified from a previous claim report. The method for revision is to reverse the entire claim and resend with modified data. This tip sheet can help providers understand the Forward Balance process used in Blue Cross and Blue Shield of Texas’ (BCBSTX) claims processing and the adjustment codes that may appear in the PLB segment. The tip sheet also includes information on PLB segment definitions and examples, as well as how to locate overpaid claims on the ERA and the paper Provider Claim Summary.
Reminder: HEDIS® Hybrid 2019 Performance Measures
Read a letter from Dr. Jerald Zarin, Medical Director, BCBSTX Medicaid and Government programs, about the performance measures for HEDIS Hybrid 2019.
Electronic Visit Verification (EVV) Updates
Past Due! Reminder to EVV Providers Transitioning to DataLogic
Providers transitioning from MEDsys VinCENT to DataLogic Vesta EVV should have completed the process by Sept. 30, 2018. If you have not yet transitioned and do not have a transition date, please contact DataLogic immediately at info@vestaevv.com. Stay up to date on all EVV changes and information via BCBSTX’s EVV page.
Featured Tip
Reminder: How to Keep the Cash Flowing: Billing BCBSTX Medicaid as a Secondary Insurance
Learn 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, then Medicaid is always the payer of last resort.
Read MoreEducation & Reference
Texas Health Steps (THSteps) Laboratory Screenings and Age-band Requirements
Review the THSteps periodicity schedule to ensure checkup components, including laboratory screenings, are being performed in a timely manner.
Read MoreFocus on Behavioral Health
Behavioral Health for School-aged Children
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.