Medicaid (STAR) and CHIP Network Participation
Medicaid (STAR) and CHIP Network Participation – Website Tour
If you are located in Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, or Williamson counties, Blue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity for participation as a provider in the BCBSTX Medicaid State of Texas Access Reform (STAR) and BCBSTX Children's Health Insurance Program (CHIP).
STAR is the Medicaid Managed Care Program for Texas. BCBSTX has been selected to provide comprehensive managed care services to the STAR program for the Texas Health and Human Services Commission (HHSC) in the Travis Service Area. Counties in the service area include Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, and Williamson.
CHIP is designed for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance for their children (up to age 19). BCBSTX has been selected to provide comprehensive managed care services to the CHIP program for the Texas HHSC in the Travis Service Area.
The HHSC has contracted with BCBSTX to provide comprehensive managed care services for the STAR and CHIP programs that will include, among other things, network development, provider contracting and education, and coordination with provider and treatment facilities. Your network participation will ensure the success of these two very important programs.
Medical/Surgical Physicians and Professional Providers
In order to participate in Medicaid (STAR) and CHIP, physicians and professional providers must have:
- Privileges at a STAR and CHIP participating hospital (unless inpatient admissions are uncommon or not required for the physician's and professional provider's specialty)
- A valid National Provider Identifier (NPI) number
- A valid Medicaid Texas Provider Identifier (TPI) number (applies to STAR only)
- Attestation (registration and reporting of NPI number) with the State of Texas
Additional credentialing will not be required for those providers already credentialed in the BlueChoice® or HMO Blue® Texas networks and whose recredentialing is current.
As a participating BCBSTX STAR and CHIP professional provider, you will be reimbursed 100% of the State of Texas Medicaid fee schedule, current for that date-of-service. Access State of Texas Medicaid Fee Schedule
If you have questions, please contact your local Network Management office in Austin at 512-349-4876 or 800-336-5696 (press 1, enter extension 44876).
If you are one of the following physicians or other professional providers interested in participating in the Medicaid STAR and CHIP program, please refer to the contact list below:
- Behavioral Health Professionals and Physicians – contact Magellan Health Services at 800-788-4005 or Magellan Health Services .
- Pharmacy Providers – contact Express Scripts
- Vision Providers – contact Davis Vision
To become a Medicaid (STAR) provider you must attest (register and report) your NPI with Texas Medicaid and Healthcare Partnership (TMHP).
For more information, please visit TMHP Provider Enrollment .
Note: You cannot be reimbursed for Medicaid services without attesting with TMHP.
Participating physicians, professional providers, and facility providers are requested to submit claims electronically to Blue Cross and Blue Shield of Texas within 95 days of the date of service, or by using the standard CMS-1500 or UB04 claim form.
Note: If submitting claims by paper, send claims to:
Blue Cross and Blue Shield of Texas
P.O. Box 684787
Austin, TX 78768
Services billed beyond 95 days from the date of service are not eligible for reimbursement.
Participating physicians, professional providers, and facility providers may not seek payment from the member for claims submitted after the 95 day filing deadline.
View frequently asked questions regarding STAR and CHIP requirements for participation, credentialing, reimbursement, and where to find more information.
Cultural and Linguistic Provider Resources
Blue Cross and Blue Shield of Texas recognizes the importance of providing culturally and linguistically appropriate health care related services to members. To support providers in this effort, we provide educational material on providing culturally competent care, access to telephonic and face-to-face interpreters, as well as guidelines for assessing the bilingual capability of provider office staff.
To request more information on the BCBSTX Medicaid (STAR) and CHIP Cultural and Linguistic program please contact the Texas Medicaid Network Department at 512-349-4876.
Please Join Blue Cross and Blue Shield of Texas for
Informative STAR and CHIP Training Webinars
BCBSTX is hosting Provider Training webinars. These webinars will give providers and their staff an orientation to BCBSTX STAR and CHIP programs and services.
Your Opinion Matters
Because your opinions matter to BCBSTX, you will be asked to share your comments about the webinars in a brief evaluation at the conclusion of the session. We also use this as confirmation of your attendance. View Evaluation
The PowerPoint presentation from your session will be available for you to download by clicking on the handouts icon in the top right corner of the webinar. We encourage you to save a copy to share with your team or for future reference.
- A Comprehensive Overview
- Ancillary Provider Training
- Claims Billing and Authorization Training
- Facility Provider Orientation
- FQHC/RHC Claims and Billing Training
- Medical Management Training
- OB/GYN Training
- Provider Network and Credentialing Training
- Provider Orientation
- Texas Health Steps Training
- Value Added Services Training
|Medicaid (STAR) and CHIP Training Sessions|
|Note: All webinars are scheduled from 12 Noon – 2 p.m., Central Time.|
|Schedule for February 2013|
|Tuesday, February 19 Note 9||Thursday, February 28 Note 10|
|Note 1:||Ancillary Provider Training – Overview of billing and authorization requirements|
|Note 2:||Texas Health Steps – Provide clinical overview of the components of THSteps, information for the identification of children of Migrant Farm workers|
|Note 3:||Provider Orientation - Comprehensive Overview|
|Note 4:||Medical Management Webinar – Provide an overview of the authorization guidelines, any updates, and an overview of the authorizations/referrals process|
|Note 5:||Provider Network and Credentialing – Provide an overview of the Credentialing process and Network requirements|
|Note 6:||Provider Cultural and Linguistic Toolkit – Provide training on BCBSTX Medicaid's Cultural toolkit used to heighten awareness of cultural sensitivity, and to provide information to access interpreter services|
|Note 7:||OB/GYN Provider Training – Provide information regarding newborn notification report, Pregnancy Notification report, and to describe the process to report high risk pregnancies to case management|
|Note 8:||Provider Cultural and Linguistic Toolkit - Provide training on BCBSTX Medicaid's Cultural toolkit used to heighten awareness of cultural sensitivity, and to provide information to access interpreter services.|
|Note 9:||Claims & Billing Webinar – Discuss unique Claims & Billing requirements. Also, briefly discuss prior authorization process.|
|Note 10:||Children of Migrant Farmworkers – In-depth look at the Children of Migrant Farmworkers Population, including Children of Migrant Farmworkers identification, demographics, occupational risks, and impact on healthcare delivery.|
Please call your local Network Management office in Austin at 512-349-4876 or 800-336-5696 (press 1, enter extension 44876).
- Submit Texas Health Steps Claims on CMS-1500
- Include Benefit code “EP1” in field 11
- Diagnosis code "V20.2"
- No rendering National Provider Identifier required for Texas Health Steps
- No requirement to bill Other Insurance Coverage for Texas Health Steps
Texas Health Steps Educational Information
- Children of Migrant Farm Workers
- DME/Medical Supplies
- Freh v Suehs Consent Decree and Corrective Action Orders
- Medical Transportation Program Services
- Member Complaints Appeals Fair Hearing
- Pharmacy Services
- TX Health Steps Benefits
- TX Health Steps Missed Appointments
- TX Health Steps Periodicity and Checkup Elements
For BCBSTX CHIP members, use the Blue Cross and Blue Shield of Texas preventive care forms. These forms are located under the Medicaid (STAR) and CHIP Clinical Practice Tools Tab.