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Alert: Medicaid Members Can't be Balance Billed

06/23/2023

Reminder

Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid reminds all Medicaid doctors or hospitals who accept Medicaid – STAR, STAR Kids, and CHIP plans are prohibited from balance billing our members for services that Medicaid covers. (Note: CHIP members are responsible for their co-payments, co-insurance, and deductibles as applicable).

What is Balance Billing?

Balance billing is the practice in which providers bill Medicaid and CHIP eligible members for covered services. A member cannot be billed for charges beyond reimbursement paid under Texas Medicaid for covered services.

Act Now

  • Verify member’s eligibility prior to every service. Providers who are registered with Medicaid may visit the TMHP website to verify members’ eligibility if our member forgot their insurance card.
  • Availity is an application your office can register with at no cost to verify member coverage.

Helpful Reminders:

  • A member should never receive a “balance bill” for any medical services from a provider under Medicaid and CHIP benefits.
    • Exception: If an organizational determination has been made and a prior written agreement has been signed by both the provider and the BCBSTX member for non-covered services.
  • If a provider has balance-billed a Medicaid or CHIP member, the provider must take prompt action to resolve the situation and avoid these billing practice in the future. The provider must stop the bill collection process and work with credit reporting agencies to correct any resulting issues for the member.
  • A provider must accept payment in full; from the member’s Medicaid or CHIP plan and should not deny any services to members for non-payment.
  • A member cannot be required to make a down payment for Medicaid-allowable services.
  • Medicaid covers additional benefits, such as Long-Term Services and Supports (LTSS).
  • A provider must obtain a written waiver signed by the member for non-covered benefits prior to providing any services to the member.
  • A provider may review their remittance advice notice to help determine provider and member responsibility.

Additional Information:

For more information regarding billing STAR, STAR Kid, and CHIP members, please visit the Texas Medicaid & Healthcare Partnership (TMHP) website at www.tmhp.com/HTMLmanuals/TMPPM.

Questions

If you have questions about our Medicaid members, please call the phone number listed on the back of the member’s BCBSTX identification card. Or you may reach out to your Medicaid Provider Network Representative by: