Provider Alert! Changes to the STAR Kids LTSS Billing Matrix and Crosswalk Effective December 1, 2022
Date: October 27, 2022
Attention: All Providers
Effective Date: December 1, 2022
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action:
UPDATE October 27, 2022: Texas Children’s’ Health Plan (TCHP) would like to communicate with providers that we have worked diligently ahead of the go live date of December 1, 2022, to make the transition to the STAR Kids LTSS Billing Matrix as seamless as possible in regards to prior authorizations.
- New authorization with codes and modifiers will not be required. Current authorizations will pay.
- Each provider group has multiple codes and modifier combinations that have been pre-approved based on their prior authorizations.
- For example, on November 30, 2022, providers with existing prior authorizations should bill with the current codes/modifier combination and on December 1, 2022, they will bill with the new codes/modifiers under the same authorization number.
UPDATE October 10, 2022: On June 1, 2022, the Health and Human Services Commission (HHSC) comprehensively revised the Long-Term Services and Supports (LTSS) Billing Matrices and incorporated National Correct Coding Initiative (NCCI)-related revisions.
The changes for STAR Kids/STAR Health include the following:
- A new row 1 containing a revision date was added to the matrix.
- Row 2 was amended to read, “*All services and HCPCS codes are applicable to STAR Health. Modifiers do not apply to STAR Health.”
- A new row was added for T2002 with a U6 modifier with description that reads, “Prescribed Pediatric Extended Care transportation (MDCP)”
- Row 37 in the “Summary of Changes” tab was amended to read, “Updated to CFC / MDCP only as this is paid through CFC”
Texas Children’s Health Plan (TCHP) would like to remind providers of the effective date of December 1, 2022, for the revised LTSS billing matrix. STAR Kids Handbook Appendix III, STAR Kids LTSS Billing Matrix and Crosswalk: https://www.hhs.texas.gov/handbooks/star-kids-handbook/appendix-iii-ltss-billing-matrix-crosswalk
How this impacts providers: As a reminder, prior authorizations must be submitted using new codes and modifiers beginning October 17, 2022, for services effective on or after December 1, 2022. Prior authorizations for services on or after December 1, 2022, using old codes and modifiers will not be accepted.
Next steps for providers: Providers are encouraged to share this communication with their staff. There is no required action; a current authorization on file is still valid after December 1, 2022.
Information that was previously published, http://www.thecheckup.org/2022/10/12/provider-alert-changes-to-the-star-kids-ltss-billing-matrix-and-crosswalk-effective-december-1-2022/
http://www.thecheckup.org/2022/08/08/provider-alert-changes-to-the-star-kids-ltss-billing-matrix/
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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