Blue Review
A newsletter for Medicaid providers

September 2018

Hot Topics

HEDIS® 2019 – Technical Specification Updates

Find out about the technical specifications changes for the 2018 HEDIS measurement year. A table is provided reflecting the measures assessed, measure details and associated changes per measure.

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Government Programs: Electronic Claim-related Process Improvements and Reminders

Beginning Sept. 15, Blue Cross and Blue Shield of Texas (BCBSTX) will implement a claims processing change to stop duplicate claim rejections. Currently, these rejections are happening when professional and institutional electronic claims (837P and 837I transactions) are resubmitted within 90 days of a previously submitted claim that include the exact data for the same patient and date of service.

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Focus on Behavioral Health

September Is National Suicide Prevention Awareness Month

This month, BCBSTX is sharing resources to help you help your patients who are struggling with suicidal risks.

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Education & Reference

Electronic Visit Verification (EVV) Updates

Providers who did not transition to the Vesta® EVV system on or before Sept. 30, 2018, may be unable to record EVV visits for transmission to payers. Providers who submit claims without EVV visits may have claims denied or recouped by payers. Also, revisions have been made to the EVV Unallowable Phone Identification and Recoupment policy. Be sure you are up to date on EVV changes and information. Recent posts can be found on BCBSTX’s EVV page.

The Importance of Well-care Visits During Periods of Transformation

The transition from adolescence to young adulthood is an important time for kids to develop good habits that can last through adulthood. During annual preventive exams, providers can teach healthy habits, as well as identify behaviors that may result in negative health outcomes.

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Be Prepared – Synagis Season Is Coming

Respiratory Syncytial Virus (RSV) season is almost here. For the 2018-19 season, BCBSTX Medicaid and CHIP will be following the 2014 American Academy of Pediatrics schedule recommendations. The Task Group has reviewed more than 15 years of epidemiologic data and recommends the period for prophylaxis in the Travis and Central Texas service areas to be from Oct. 15, 2018, to March 15, 2019. Because we allow a maximum of five injections of Synagis a season, it is important to be aware of the current epidemiology. Note: BCBSTX requires STAR/CHIP and STAR Kids prior authorization forms for Synagis.

Health & 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.

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.

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:
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