August 24, 2022
Reminder
This is a friendly reminder to our Blue Cross and Blue Shield of Texas (BCSTX) Medicaid providers regarding proper documentation for Primary Care Physicians (PCP) and Private Duty Nursing (PDN) services. Failure to sign and return PDN documents in a timely manner may cause a denial of services or lapse in coverage for our members. Please see PCP signature requirements below.
What’s the process?
The POC developed by the Registered Nurse (RN) and represents the treating physician’s orders must be:
- Recommended, signed, and dated by the treating physician no more than 30 days before the start of care or 30 days before the end of the prior authorization period.
- Reviewed and revised by the treating physician with each prior authorization, or more frequently as the treating physician or the PDN services provider deems necessary.
Steps for successful prior authorization requirements:
- Obtaining physician signatures for all telephone orders within 14 calendar days of receipt of the order.
- The Plan of Care (POC) must be recommended, signed, and dated by the member’s primary care physician.
- The PCP must review and revise the POC, in consultation with the provider and the responsible adult, for each prior authorization, or more frequently as the physician deems necessary or the member’s situation changes.
For additional information please reference Texas Medicaid Provider Procedures Manual (TMPPM); Home Health and Nursing and Private Duty Nursing Handbook Volume 2 August 2022.
Questions
For questions or additional information, please contact:
- The BCBSTX Medicaid Provider Service Center at 1-877-560-8055
- Your Texas Medicaid Network team at 1-855-212-1615
- Submit via email Texas Medicaid Network Department.