Is blue cross community health plan medicaid

BCBSTX STAR Plan

The STAR program is for people who qualify for Medicaid and who are either pregnant, have limited income, are newborns or receive cash assistance (Temporary Assistance for Needy Families or TANF). BCBSTX is pleased to offer a STAR plan for people and families who qualify under Medicaid. We have served STAR members in the Travis Service Area since 2012.

View Participating Counties

Member Handbook

Member Resources

• Community Advisory Committee

  Each quarter, BCBSTX holds a Community Advisory Committee (CAC) Meeting so that we can find out how we can serve you better.

  If you would like to come and share your ideas with BCBSTX staff and community partners on what you like about your plan benefits or where we can do better, please call the member advocate toll-free for details at 1-877-375-9097 (TTY 711).

  Learn about upcoming Community Advisory Committee meetings.
   

• Primary Care Provider (PCP) Information

  You must choose a PCP from the Provider Network when you join. You can choose a different PCP for each member. A PCP is your main health care provider and will arrange your care with other doctors and hospitals. Your PCP can be a:

  • Pediatrician
  • Family or General Practitioner
  • Obstetrician/Gynecologist (OB/GYN)
  • Internist (Internal Medicine)
    
  • Nurse Practitioner (NP) or Physician Assistant (PA)
    Clinic such as Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs)

  You can call customer service for help choosing a PCP or use the Provider Finder®.

• Referral Information

  BCBSTX allows members with special health care needs to have direct access to the right specialists for their conditions and identified needs. This includes a standing referral to a specialty doctor, or having a specialist as a PCP if needed.

  Mental Health/Substance Abuse services do not need an OK from your PCP when you are not in the hospital, but you do have to see a Magellan provider. If you have questions, call Magellan Health Services at 1-800-327-7390 (TTY 1-800-735-2988). You can call 24 hours a day, 7 days a week.

  Some PCPs and OB/GYNs offer family planning. You do not need an OK from your PCP to get family planning help. Members may use any qualified family planning clinic, certified nurse midwife or provider. The provider does not need to be part of BCBSTX.

• Member Rights and Responsibilities

• Complaints

  If you are not satisfied with your care, you can file a complaint.

• Appeals

  You have the right to ask for an appeal. Learn how to file an appeal with BCBSTX.

• Lost/Stolen ID Card

  Call customer service at 1-888-657-6061 (TTY 711) to replace your ID card if it is lost.

• Notice of Privacy Practices

• Office of Consumer Credit Commissions

  Visit the Office of Consumer Credit Commissions (OCCC) website to get tools and skills to help you make informed financial decisions. The OCCC has resources to help understand your financial choices and obligations. Knowing your choices makes it easier to manage your personal finances so you can meet your financial goals.

• Report Fraud, Waste and Abuse

  We are part of the Inspector General Integrity Initiative and have pledged to partner with the Office of Inspector General (OIG) to fight fraud, waste and abuse in Texas' Medicaid program. To learn more, visit the OIG website.

Important Contact Information

• Customer Service Hotline

  Call customer service at 1-888-657-6061 (TTY 711). We are open 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday. You can speak with someone in English or Spanish. You can also speak with someone about how to get information in other languages or formats at no extra charge. You may also request interpreter services.

  You may leave a voice mail outside of our normal business hours or on weekends and holidays.

  If you are experiencing an emergency, call 911 or go to the nearest hospital emergency room.

• Behavioral Health Services Hotline

  For the Behavioral Health Services Hotline, call Magellan Health Services at 1-800-327-7390 (TTY 1-800-735-2988). You can call 24 hours a day, 7 days a week.

  You can speak with someone in English or Spanish. You may also request interpreter services.

  Mental Health/Substance Abuse services do not need an OK from your PCP when you are not in the hospital, but you do have to see a Magellan provider.

  Magellan also offers emergency and crisis support. If you or your child is having a mental health emergency, call Magellan. You may call at any time of day or night, and on any day of the week.

• 24/7 Nurse Hotline

  For the 24/7 Nurse Hotline, call 1-844-971-8906 (TTY 711). You can speak with someone in English or Spanish. You may also request interpreter services.

  This help line is staffed 24 hours a day, 7 days a week with registered nurses who can help you get answers to your health questions. If an unexpected medical situation arises, a nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem yourself.
   

• Texas Health Steps Contact Information

  If you need to contact Texas Health Steps, call them toll-free at 1-877-847-8377 (1-877-THSTEPS).

  Learn more about Texas Health Steps.

• STAR Program Enrollment Broker Contact Information

  If you need help choosing a health plan, call 1-800-964-2777. You can call Monday to Friday, 8:00 a.m. to 6:00 p.m. Central Time.

• Fair Hearing Contact Information

  If you do not agree with a decision BCBSTX has made about your request for benefits or services, you have the right to ask for a Medicaid fair hearing from the Health and Human Services Commission (HHSC). The HHSC hearings officers will hear your case, look at the evidence and make a decision based on state and federal rules, regulations and laws.

  To ask for an appeal or a fair hearing, call the Member Advocate in the Travis service area at 1-877-375-9097 (TTY 711) from 8:30 a.m. to 5:00 p.m. Central Time, Monday to Friday. View more information on asking for a fair hearing.

  You can also learn more about filing an appeal.

• Provider Services Hotline

  If your provider needs to contact us, they may call the Provider Services Hotline at 1-877-560-8055 from 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday.

  Your provider can contact us with questions about eligibility, benefits, provider network referrals or claim statuses. They can also contact us about appeals and complaints.

• Alternative Formats

  To get auxiliary aids and services, or to get written or oral interpretation to understand the information given to you, including materials in alternative formats such as large print, braille or other languages, please call BCBSTX STAR Customer Service at 1-888-657-6061 (TTY 711).

Information About Your Prescription, Vision, Dental and Behavioral Health Benefits

• Prescription Benefits

  Your prescription benefits are administered by BCBSTX. For questions about drug coverage, please contact us at 1-888-657-6061 (TTY 711).

  Prior Authorization Forms

  View your drug coverage.

• Vision Benefits

  Your vision coverage includes an eye exam every 12 months and glasses or contact lenses, when medically necessary.

  Your vision benefits are administered by Davis Vision. For questions about your vision coverage, please call BCBSTX customer service at 1-888-657-6061 (TTY 711).

  View your vision coverage.

• Dental Benefits

  Children on Medicaid receive dental benefits that are administered by either Dentaquest or MCNA Dental. Please call them directly to learn more about your child’s dental coverage:

  Call Dentaquest at 1-800-516-0165 and MCNA Dental at 1-800-494-6262.

  If you do not know your child's dental plan, call the enrollment broker at 1-800-964-2777.

  View your child’s dental coverage.

• Behavioral Health Benefits

  BCBSTX works with Magellan Health Services (Magellan) for mental health and substance abuse services. For questions about your behavioral health coverage, please call Magellan directly at 1-800-327-7390 (TTY 1-800-735-2988).

  View your behavioral health coverage.

Find a Doctor or Hospital

Use our Provider Finder® to search for doctors and pharmacies near you.

Contact Us

If you have questions, please call customer service toll-free at 1-888-657-6061 (TTY 711).

BCBSTX CHIP Plan

The CHIP and CHIP Perinatal program is available to children (age 18 and younger) and pregnant women who do not qualify for Medicaid. BCBSTX is pleased to provide a CHIP plan. We have served CHIP members in the Travis Service Area since 2012.

View Participating Counties

Member Handbook

Member Resources

• Community Advisory Committee

  Each quarter, BCBSTX holds a Community Advisory Committee (CAC) Meeting so that we can find out how we can serve you better.

  If you would like to come and share your ideas with BCBSTX staff and community partners on what you like about your plan benefits or where we can do better, please call the member advocate toll-free for details at 1-877-375-9097 (TTY 711).

  Learn about upcoming Community Advisory Committee meetings  

• Primary Care Provider (PCP) Information

  You must choose a PCP from the Provider Network when you join. You can choose a different PCP for each member. A PCP is your main health care provider and will arrange your care with other doctors and hospitals. Your PCP can be a:

  • Pediatrician
  • Family or General Practitioner
  • Obstetrician/Gynecologist (OB/GYN)
  • Internist (Internal Medicine)
  • Nurse Practitioner (NP) or Physician Assistant (PA)
  • Clinic such as Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs)

  You can call customer service for help choosing a PCP or use the Provider Finder®.

• Referral Information

  BCBSTX allows members with special health care needs to have direct access to the right specialists for their conditions and identified needs. This includes a standing referral to a specialty doctor, or having a specialist as a PCP if needed.

  Mental Health/Substance Abuse services do not need an OK from your PCP when you are not in the hospital, but you do have to see a Magellan provider. If you have questions, call Magellan Health Services at 1-800-327-7390 (TTY 1-800-735-2988). You can call 24 hours a day, 7 days a week.

  Some PCPs and OB/GYNs offer family planning. You do not need an OK from your PCP to get family planning help. Members may use any qualified family planning clinic, certified nurse midwife or provider. The provider does not need to be part of BCBSTX.

  If you need help finding a specialty doctor, mental health/substance abuse services or an OB/GYN provider, call Customer Service at 1-888-657-6061 or TTY 711.

  You do not need a referral to get emergency services. You should call your child’s PCP after the emergency so follow-up care can be planned. This should be done for any emergency at home or away.

• Copay Information

  Some CHIP members have copays. Your member's card shows if you have one. You can view copays for different services, based on income guidelines.

• Member Rights and Responsibilities

• Complaints

  If you are not satisfied with your care, you can file a complaint.

• Appeals

  You have the right to ask for an appeal. Learn how to file an appeal with BCBSTX.

• Lost/Stolen ID Card

  Call customer service at 1-888-657-6061 (TTY 711) to replace your ID card if it is lost.

• Notice of Privacy Practices

• Office of Consumer Credit Commissions

  Visit the Office of Consumer Credit Commissions (OCCC) website to get tools and skills to help you make informed financial decisions. The OCCC has resources to help understand your financial choices and obligations. Knowing your choices makes it easier to manage your personal finances so you can meet your financial goals.

• Report Fraud, Waste and Abuse

  We are part of the Inspector General Integrity Initiative and have pledged to partner with the Office of Inspector General (OIG) to fight fraud, waste and abuse in Texas' Medicaid program. To learn more, visit the OIG website.

Important Contact Information

• Customer Service Hotline

  Call customer service at 1-888-657-6061 (TTY 711). We are open 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday. You can speak with someone in English or Spanish. You can also speak with someone about how to get information in other languages or formats at no extra charge. You may also request interpreter services.

  You may leave a voice mail outside of our normal business hours or on weekends and holidays.

  If you are experiencing an emergency, call 911 or go to the nearest hospital emergency room.

• Behavioral Health Services Hotline

  For the Behavioral Health Services Hotline, call Magellan Health Services at 1-800-327-7390 (TTY 1-800-735-2988). You can call 24 hours a day, 7 days a week.

  You can speak with someone in English or Spanish. You may also request interpreter services.

  Mental Health/Substance Abuse services do not need an OK from your PCP when you are not in the hospital, but you do have to see a Magellan provider.

  Magellan also offers emergency and crisis support. If your child is having a mental health emergency, call Magellan. You may call at any time of day or night, and on any day of the week.
   

• 24/7 Nurse Hotline

  For the 24/7 Nurse Hotline, call 1-844-971-8906 (TTY 711). You can speak with someone in English or Spanish. You may also request interpreter services.

  This help line is staffed 24 hours a day, 7 days a week with registered nurses who can help you get answers to your health questions. If an unexpected medical situation arises, a nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem yourself.
   

• CHIP Program Enrollment Broker Contact Information

  If you need help choosing a health plan, call 1-800-964-2777. You can call Monday to Friday, 8:00 a.m. to 6:00 p.m. Central Time.

• Provider Services Hotline

  If your provider needs to contact us, they may call the Provider Services Hotline at 1-877-560-8055 from 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday.

  Your provider can contact us with questions about eligibility, benefits, provider network referrals or claim statuses. They can also contact us about appeals and complaints.

• Alternative Formats

  To get auxiliary aids and services, or to get written or oral interpretation to understand the information given to you, including materials in alternative formats such as large print, braille or other languages, please call BCBSTX CHIP Customer Service at 1-888-657-6061 (TTY/TDD 711).
  

Information About Your Prescription, Vision, Dental and Behavioral Health Benefits

• Prescription Benefits

  Your child's prescription benefits are administered by BCBSTX. For questions about drug coverage, please contact us at 1-888-657-6061 (TTY 711).

  View your child's drug coverage.

• Vision Benefits

  Your child's vision coverage includes an eye exam every 12 months and one pair of non-prosthetic eyewear every 12 months.

  Your child’s vision benefits are administered by Davis Vision. For questions about your child's vision coverage, please call BCBSTX customer service at
  1-888-657-6061 (TTY 711).

  View your child's vision coverage.
   

• Dental Benefits

  Your child's dental benefits are administered by either Dentaquest or MCNA Dental. Please call them directly to learn more about your child's dental coverage:

  Call Dentaquest at 1-800-516-0165 and MCNA Dental at 1-800-494-6262.

  If you do not know your child's CHIP dental plan, call the CHIP enrollment broker at 1-800-964-2777.

  View your child’s dental coverage.

• Behavioral Health Benefits

  BCBSTX works with Magellan Health Services (Magellan) for mental health and substance abuse services. For questions about your child's behavioral health coverage, please call Magellan directly at 1-800-327-7390 (TTY 1-800-735-2988).

  View your child's behavioral health coverage.
   

Find a Doctor or Hospital

Use our Provider Finder® to search for doctors and pharmacies near you.

Contact Us

If you have questions, please call customer service toll-free at 1-888-657-6061 (TTY 711).

BCBSTX STAR Kids Plan

The STAR Kids program provides Medicaid services for children and youth age 20 and younger with disabilities. BCBSTX serves STAR Kids members in both the Travis and Central Service Areas.

Member Resources

• Member Advisory Group

  Each quarter, BCBSTX holds a Member Advisory Group (MAG) meeting so that we can find out how we can serve you better.

  If you would like to come and share your ideas with BCBSTX staff and community partners on what you like about your plan benefits or where we can do better, please contact the STAR Kids member advocate in your area for details. For the Travis Service Area call toll-free at 1-877-375-9097, or in MRSA Central call 1-855-497-0857 (TTY 711).

  Learn about upcoming Member Advisory Group meetings.

• Primary Care Provider (PCP) Information

  Please choose a PCP from the provider network when you join. If your child sees and out-of-network PCP or a PCP from a non-Medicaid plan, we can help you stay with that PCP. You should let us know If you would like your child's specialist to be their PCP.

  Please call Service Coordination so we can get information on PCP that you want to use, and we will help get the appropriate PCP assigned. After you choose a PCP, you will then get a new ID card that shows “Commercial PCP” or “Dual Eligible” for members that have Medicare. You can call customer service for help choosing an in-network PCP or you can use Provider Finder®.

• Referral Information

  You do not need referrals to see in-network specialists. BCBSTX allows you to see out-of-network Medicaid specialists for medically necessary services.

• OB/GYN Providers

  BCBSTX also allows you to see out-of-network OB/GYN providers for medically necessary services. You should notify a service coordinator if you are going to see an out of network OB/GYN to ensure that the provider is loaded in our system so that they can file claims.

• Behavioral Health and Substance Abuse Treatment Services

  You do not need a referral for behavioral health or substance abuse treatment services to see a Magellan network provider. BCBSTX STAR Kids members get behavioral health/substance abuse services through Magellan Health Services.

  If you want to see an out-of-network provider, you need to get a prior authorization for to ensure Magellan has the provider information needed to accurately pay claims. A Magellan Health Care Coordinator will work with your child's service coordinator to ensure your child has access to the behavioral health services needed. You can also call Magellan at 1-800-424-0324.

• Member Rights and Responsibilities

• Complaints

  If you are not satisfied with your care, you can file a complaint.

• Appeals

  You have the right to ask for an appeal. Learn how to file an appeal with BCBSTX.

• Lost/Stolen ID Card

  Call customer service at 1-877-688-1811 (TTY 711) to replace your ID card if it is lost.

• Notice of Privacy Practices

• Office of Consumer Credit Commissions

  Visit the Office of Consumer Credit Commissions (OCCC) website to get tools and skills to help you make informed financial decisions. The OCCC has resources to help understand your financial choices and obligations. Knowing your choices makes it easier to manage your personal finances so you can meet your financial goals.

• Report Fraud, Waste and Abuse

  We are part of the Inspector General Integrity Initiative and have pledged to partner with the Office of Inspector General (OIG) to fight fraud, waste and abuse in Texas' Medicaid program. To learn more, visit the OIG website.

Important Contact Information

• Customer Service Hotline

  Call customer service at 1-877-688-1811 (TTY 711). We are open 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday. You can speak with someone in English or Spanish. You can also speak with someone about how to get information in other languages or formats at no extra charge. You may also request interpreter services.

  You may leave a voice mail outside of our normal business hours or on weekends and holidays.

  If you are experiencing an emergency, call 911 or go to the nearest hospital emergency room.

• Service Coordination Contact Information

  Service coordination assists you and your child in coordinating acute and long-term care services. All members receiving long-term services and supports, or those who request them will receive service coordination services from BCBSTX STAR Kids.

  For Service Coordination, call 1-877-301-4394 (TTY 711), 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday.

  Find more information about your child's assigned service coordinator by logging in to Blue Access for MembersSM (BAM). In BAM, you can view the service coordinator's name, phone number, and email address.
   

• Behavioral Health Services Hotline

  For the Behavioral Health Services Hotline, call Magellan Health Services at 1-800-424-0324 (TTY 1-800-635-2883). You can call 24 hours a day, 7 days a week.

  You can speak with someone in English or Spanish. You may also request interpreter services.

  You do not need a referral for behavioral health or substance abuse treatment services to see a Magellan network provider. BCBSTX STAR Kids members get behavioral health/substance abuse services through Magellan Health Services.

  A Magellan Health Care Coordinator will work with your child’s service coordinator to ensure your child has access to the behavioral health services needed. You can also call Magellan directly. All members receiving long-term services and supports, or those who request them will receive service coordination services from BCBSTX STAR Kids.

  Magellan also offers emergency and crisis support. If your child is having a mental health emergency, call Magellan. You may call at any time of day or night, and on any day of the week
   

• 24/7 Nurse Hotline

  For the 24/7 Nurse Hotline, call 1-855-802-4614 (TTY 711). You can speak with someone in English or Spanish. You may also request interpreter services.

  This help line is staffed 24 hours a day, 7 days a week with registered nurses who can help you get answers to your health questions. If an unexpected medical situation arises, a nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem yourself.

• Texas Health Steps Contact Information

  If you need to contact Texas Health Steps, call them toll-free at 1-877-847-8377 (1-877-THSTEPS).

  Learn more about Texas Health Steps.

• STAR Kids Program Enrollment Broker Contact Information

  If you need help choosing a health plan, 1-877-782-6440. You can call Monday to Friday, 8:00 a.m. to 6:00 p.m. Central Time.

• Fair Hearing Contact Information

  If you do not agree with a decision BCBSTX has made about your request for benefits or services, you have the right to ask for a Medicaid fair hearing from the Health and Human Services Commission (HHSC). The HHSC hearings officers will hear your case, look at the evidence and make a decision based on state and federal rules, regulations and laws.

  To ask for an appeal or a fair hearing, call the Member Advocate in the Travis service area at 1-877-375-9097 (TTY 711). For the Member Advocate in the Central MRSA service area, call 1-855-497-0857 (TTY 711). Call between 8:30 a.m. and 5:00 p.m. Central Time, Monday to Friday. View more information on asking for a fair hearing.

  You can also learn more about filing an appeal.
   

• Provider Services Hotline

  If your provider needs to contact us, they may call the Provider Services Hotline at 1-877-784-6802 from 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday.

  Your provider can contact us with questions about eligibility, benefits, provider network referrals or claim statuses. They can also contact us about appeals and complaints.

• Alternative Formats

  To get auxiliary aids and services, or to get written or oral interpretation to understand the information given to you, including materials in alternative formats such as large print, braille or other languages, please call BCBSTX STAR Kids Customer Service at 1-877-688-1811 (TTY 711).

Information About Your Prescription, Vision, Dental and Behavioral Health Benefits

• Prescription Benefits

  Your child's prescription benefits are administered by BCBSTX. For questions about drug coverage, please contact us at 1-877-688-1811 (TTY 711).

  View your child's drug coverage.

• Vision Benefits

  Your child's vision coverage includes an eye exam every 12 months and one pair of non-prosthetic eyewear every 12 months.

  Your child’s vision benefits are administered by Davis Vision. For questions about your child's vision coverage, please call BCBSTX customer service at 1-877-688-1811 (TTY 711).

  View your child's vision coverage.

• Dental Benefits

  Your child's dental benefits are administered by either Dentaquest or MCNA Dental. Please call them directly to learn more about your child's dental coverage:

  Call Dentaquest at 1-800-516-0165 and MCNA Dental at 1-800-494-6262.

  If you do not know your child's CHIP dental plan, call the STAR Kids enrollment broker at 1-877-782-6440(toll-free) 8 a.m. to 6 p.m. Central Time, Monday to Friday. If you have a speech or hearing disability, call 711 or 1-800-735-2989 (toll-free).
  

  View your child’s dental coverage.

• Behavioral Health Benefits

  BCBSTX works with Magellan Health Services (Magellan) for mental health and substance abuse services. For questions about your child's behavioral health coverage, please call Magellan directly at 1-800-424-0324 (TTY 1-800-635-2883).

  View your child's behavioral health coverage.
   

Find a Doctor or Hospital 

Use ourProvider Finder® to doctors and pharmacies near you.

Contact Us

If you have questions, please call customer service toll-free at 1-877-688-1811 (TTY 711).

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