Blue Cross Blue Shield Texas Star Medicaid

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Support For Superior Members Affected By Severe Weather

Backpack Giveaway Benefits Austin Kids During COVID

If you are a member of Superior HealthPlan and are located in an area affected by severe weather, there are services available to help you.

All Superior members who live within the official disaster designated counties and who may need to replace necessary medical equipment, services, or supplies should seek replacement through any available supplier. If you cannot find a supplier, call Member Services to find one for you. Your supplies will be replaced even if you are temporarily outside of the county in which you live.

Blue Cross And Blue Shield Of Texas Offers New Coordinated Health Care Plan For Children With Special Healthcare Needs And Families

RICHARDSON Starting November 1, 2016, Texas families that have children with special healthcare needs will have access to tailored, coordinated healthcare for the first time.

Texas children and young adults who either receive Supplemental Security Income Medicaid or are enrolled in the Medically Dependent Children Program will be able to receive services through a STAR Kids health plan offered by Blue Cross and Blue Shield of Texas in the Metropolitan – Central Texas and Travis service areas.

The new STAR Kids program will offer streamlined access to the medical, behavioral, social and developmental services and supports needed by children with special healthcare needs and young adults and their families to help sustain the child in their home and community. Through its team of trained service coordinators, BCBSTX will deliver individualized service plans that provide the right care, in the right place and at the right time for the qualified enrollee population residing in the 39 counties contained in the two above mentioned service areas.

BCBSTX has also implemented a Medicare Advantage – Dual Special Needs Plan to serve STAR Kids members who are dually eligible under Medicare and Medicaid programs in select counties.

Additional information on STAR Kids and BCBSTX may be obtained by calling 1-877-688-1811, or visiting BCBSTX’s specifically created website, .

Active Managed Care Plans As Of September 2017

Health Insurance Carrier
COMM HLTH CHO KELSEY ExchangeHealth Insurance Exchange
Commercial, Managed Medicare, Managed Medicaid
Corvel Corporation
Commercial, Managed Medicare, Managed Medicaid, Health Insurance Exchange
United Behavioral HealthCommercial, Managed Medicare, Managed Medicaid
United Evercare Star Plus
United TX Star_CHIP/ Evercare -StarManaged Medicaid
HCA EMPLOYEE INSURANCECommercial

*Note: This list may change periodically. Please verify participation status with your health insurance carrier as benefit plans are continuously updated.

The Womans Hospital of Texas7600 Fannin

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Health Insurance Plan Information Applies To The Following Locations:

Texas Childrens Hospital Locations

  • Texas Childrens Hospital
  • Texas Childrens Pavilion for Women
  • Texas Childrens Hospital West Campus
  • Texas Childrens Hospital The Woodlands

Texas Children’s Health Center Locations

  • Texas Children’s Health Center – Sugar Land
  • Texas Children’s Health Center – Cy-Fair
  • Texas Children’s Health Center – Clear Lake
  • Texas Children’s Specialty Care – Upper Kirby
  • Texas Children’s Specialty Care – Kingwood Glen
  • Texas Children’s Pavilion for Women Pearland

Community Maternal Fetal Medicine Clinic Locations

  • Community Maternal Fetal Medicine Clinic – The Woodlands
  • Community Maternal Fetal Medicine Clinic – Northwest Houston
  • Community Maternal Fetal Medicine Clinic – West Houston
  • Community Maternal Fetal Medicine Clinic – Sugar Land
  • Community Maternal Fetal Medicine Clinic – Baytown
  • Community Maternal Fetal Medicine Clinic The Methodist Hospital

Below is a list of payers who are contracted with Texas Childrens Hospital, Texas Childrens Physician Service Organization, and Texas Childrens Anesthesiology. Please confirm Texas Childrens participation with your health plan as some benefit plans utilize narrow networks which may exclude Texas Childrens.

Facility-based physicians bill and collect independently for their services, and may not participate in the same insurance plans as Texas Childrens Hospital. You may receive a bill from a facility-based physician for the amount unpaid by your insurance plan.

Aetna

Availity Submit Claims Appeal Form Online

Blue Review
  • Log into the Availity Provider Portal, select Payer Spaces from the top navigation menu and select BCBSTX.
  • Within BCBSTX-branded Payer Spaces, select the Applications tab and click the BCBSTX Medicaid Provider Appeal Request Form.
  • Select Open Form, complete the downloaded form and save as a .doc or .docx file.
  • Click Add File and navigate to the folder where you saved the completed form and click Open.
  • Click Submit.
  • When the confirmation message displays, select Finish to return to the Availity Portal® Home page or click Submit Another.

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Online Eft And Era Enrollment Assistance

Learn how to enroll online for EFT and ERA transactions by referring to the Availity EFT & ERA Enrollment User Guide.

NOTE: To gain access to the above Blue Cross and Blue Shield of Texas Medicaid Tools you must be registered with Availity. Register today with no set-up fees, monthly fees or per-claim fees charged to providers by visiting the Availity website and selecting “Register”.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor directly.

Related Resources

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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Standard Prior Authorization Request Form For Health Care Services

Healthcare providers may submit their requests for prior authorization of healthcare services to Magellan using the Texas Standard Prior Authorization Request Form for Health Care Services.

The Texas Department of Insurance developed the form to be used to request prior authorization for services for commercial insured members, Medicaid, Medicaid Managed Care, the Childrens Health Insurance Program , plans covering employees of the state of Texas, school districts, and the University of Texas and Texas A& M systems.

Please select the appropriate version of the form below based on the members you serve.

Providers may continue to call Magellan with their prior authorization requests, as the form does not replace other existing methods of contacting Magellan to request a prior authorization. However, if a provider wishes to request a prior authorization by mail or fax using a form, it must be this form as prescribed by the Texas Department of Insurance.

For preauthorization of psychological testing, in addition to the Texas Standard Prior Authorization Request Form for Health Care Services, Magellan also requires the provider to complete and submit the Request for Psychological Testing Preauthorization form found on our clinical forms page.

Upon receipt of the completed form, Magellan will begin the prior authorization process.

The form cannot be used for any other purpose except to request prior authorization of a healthcare service.

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About Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit BCBS.com. We also encourage you to connect with us on , check out our videos on and follow us on .

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.

Insurance Plans Accepted By Nextcare In Texas

BlueRI for Duals (HMO D-SNP) Features & Benefits

Finding quality healthcare at an affordable price matters to everyone but its especially true in Texas.

With 4 brands and over 25 urgent care locations in the Lone Star State, we take that to heart. Thats why we accept most of Texass major insurance plans. We want to make sure you feel well-cared for, regardless of your coverage. So, in addition to accepting most insurance, we also offer medical discount programs for cash-pay patients.

PrimaCare Medical Centers Insurance Plans

Caring for the Dallas-Fort Worth Metroplex with 13 locations, PrimaCare Medical Centers in Dallas accepts most major Texas insurance plans. Visit PrimaCare.com to learn more.

PrimaCare Medical Centers Accepted Insurance Plans

Central Texas Urgent Care Plans Waco Accepted Insurance Plans

Central Texas Urgent Care, with 2 locations in Waco, has been providing affordable, convenient care for over 10 years. View all of Central Texas Urgent Cares accepted insurance plans.

Impact Urgent Care in San Antonio Accepted Insurance

San Antonio residents trust Impact Urgent Care with their immediate medical needs. View all of Impact Urgent Cares accepted insurance plans.

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Information About A Hipaa Breach With Business Partner

Superior HealthPlan is committed to protecting the privacy and security of our members information.On Oct. 27, 2021, Superior received a notice from our vendor, TTEC Healthcare Solutions, Inc. , that some of our member information was involved in a cyber incident. TTEC had the incident between March 4, 2021 and Sept. 12, 2021. .

On November 9, 2021, Superior received a notice from our vendor, Medical Review Institute of America , that some of our member information was involved in a cyber incident. Read more.

Texas Insurance Plans Accepted At Nextcare

  • Aetna
  • BCBS TX STAR CHIP Program
  • Boon Chapman Montgomery
  • Cigna Great West Houston Market
  • Cigna International
  • Coventry Health Care
  • Coventry Health Care POS
  • PHCS Scott & White Senior Plan
  • Physicians Health Choice
  • Texas Childrens CHIP Health Plan
  • Texas Childrens STAR Health Plan
  • Texas Community Care/Arcadian

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Health Insurance Exchange Plans

Aetna Austin Community Plan Any BCBS Member ID Card that has PPO in the suitcase, regardless of the product name.

Cigna LocalPlus, Cigna LocalPlus IN, Cigna Choice Fund LocalPlus, Cigna Choice Fund LocalPlus IN United Healthcare Compass/Compass Balanced, UHC Compass HMO, UHC Compass Balanced HMO, UHCCompass Plus HMO, UHC Compass Plus

Star Medicaid Managed Care Program

Provider Medicaid

Most people who have Medicaid in Texas get their coverage through the STAR managed care program. STAR covers low-income children, pregnant women and families. STAR members get their services through health plans they choose.

If you’re new to STAR, you’ll choose a health plan from the ones available in your service area . Learn more about how to choose or change your health plan.

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Medicaid Star & Chip Physician Professional Provider Facility And Ancillary Provider Provider Manual

Please access the latest version of the Medicaid STAR & CHIP Physician, Professional Provider, Facility and Ancillary Provider Provider Manual below. This manual was developed to provide you and your staff with administrative guidelines with respect to the Medicaid STAR & CHIP Networks.

From the table of contents, you can view and print content by section. This manual will be updated, as needed, and these updates will be posted to this site. These files are in a PDF format and require Adobe Reader to open and view them.

If you have trouble opening these files or accessing the information, please contact your for additional options in receiving the latest version of this manual.

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