December 8, 2022
What’s New
Blue Cross and Blue Shield of Texas (BCBSTX) identified a payment error for our Nurse Practitioners (NP) and Clinical Nurse Specialists (CNS).We have been paying impacted claims at the physician (Doctor of Medicine [MD] or doctor of osteopathy [DO]) rate rather than the reduced rate outlined in the TMHP manual.
What Dates are impacted
Dates of services from 09/01/2021-current.
Correct Payment
Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) should be paid according to Title 1 TAC §355.8281. The Medicaid rate for NPs and CNSs is 92 percent of the rate paid to a MD/DO for the same service and 100 percent of the rate paid to physicians for laboratory services, X-ray services, and injections.
Claims Reprocessing
Effective February 8, 2023, BCBSTX will reprocess impacted claims to recoup overpayments.
Questions
Providers, for questions or additional information, please:
- Contact your BCBSTX Medicaid Network team at 1-855-212-1615
- Submit via email to Texas Medicaid Network Department