Case Management for Children and Pregnant Women (CPW) Resource Tool

March 28, 2023

Reminder

For dates of services on or after September 1, 2022, Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid is responsible for managing the delivery of Children and Pregnant Women (CPW) services for BCBSTX Plans (STAR, STAR Kids) programs.

To be eligible for provision of CPW Case Management services, CPW Case Managers must be actively enrolled with Texas Medicaid through the Texas Medicaid & Healthcare Partnership (TMHP). 

Who is eligible

Registered Nurses (RNs) and Licensed Social Worker (LSWs) may enroll with Texas Medicaid to provide CPW services as an independently practicing individual or as a performing provider with a group. To enroll, they must:

• Be a (RN) with an Associate’s, Bachelor’s, or advanced nursing degree whose license is not temporary or provisional OR
• Be a (LSW) with practice appropriate licensure, including Independent Social Work, and whose license is not temporary or provisional AND
• Complete the HHSC Case Management Training before starting the CPW Medicaid provider enrolment process.

Additional information on provider qualifications and Medicaid enrollment can be located in the TMHP Provider Manual under Section 3 of the Behavioral Health and Case Management Services Handbook and in the TMHP Case Management for Children and Pregnant Women (CWP) Services Provider Quick Reference Guide.

How to join our Network

BCBSTX encourages Medicaid enrolled CPW Case managers to join our network to ensure continuity of CPW case management services for our members. Providers may request to join BCBSTX Medicaid Network by reviewing the Network Participation and How to Join Network processes which includes the Provider Onboarding Form.

How to obtain a Single Case Agreement (SCA) or Authorization

Single Case Agreements (SCA)

In lieu of contracting, BCBSTX does offer Single Case Agreements (SCA) for Out-of-Network CPW Providers or providers not wishing to contract.  

Important Tips:

• Prior authorization is needed to obtain an SCA for Out-Of-Network CPW Providers.
• SCA’s rates are based on the Texas Medicaid Fee Schedule.
• CPW Providers must be attested with Medicaid.

Assistance with Obtaining Authorization

Authorization requirements can be found in our BCBSTX Provider Manual or by contacting the BCBSTX Authorization team: 

• STAR/CHIP: 1-877-560-8055
• STAR Kids: 1-877-784-6802

BCBSTX Service Coordination Partner with CPW Case Manager Providers

•  BCBSTX Service Coordinators take a person-centered approach to service planning and discover others involved in the member’s care (including CPW Providers) during the Individual Service Plan (ISP) process.
•  When a Service Coordinator receives an CPW Referral and Intake Form (submit form via email: tx_medicaid_hc@bcbstx.com) from a CPW Provider, the service coordinator will verify if the member is already partaking in service coordination to eliminate duplicates. If it’s determined that the member is missing services not already being coordinated with BCBSTX, the CPW Provider will assist with coordinating those services. 
  

Member Can Request CPW Case Management Services

• BCBSTX Members may self-refer for CPW Case Management services. This can be done by reaching out to Service Coordinators at:
  •  STAR/CHIP SC Line: 1-877-214-5630
    
  •  STAR Kids SC Line: 1-877-301-4394
• BCBSTX members may request case management services from their Primary Care Provider. BCBSTX members who are established with a CPW Provider may continue to see their CPW Case Manager Provider. BCBSTX will honor continuity of care and work with a member's current case manager to ensure all services are being met and/or not duplicative to ongoing services.
  

How to Code and Bill for CPW

CPW Contracted Case Managers will not require authorizations for procedure code G9012 and the following modifiers used for all CPW services. Modifiers are used to identify which service component is provided. Please refer below:

Questions

Providers, for questions or additional information, please:

• Contact your BCBSTX Medicaid Network team at 1-855-212-1615
• Submit via email Texas Medicaid Network Department