Tag - STAR Kids

What does Service Coordination mean for your STAR Kids patients?

As a provider, you may have questions regarding the role Service Coordination plays in the lives of our STAR Kids members. At Texas Children’s Health Plan, the goal of Service Coordination is to optimize health to ensure that the member’s tomorrow is better than his or her today. Service Coordination is a person-centered approach to care and each of our members is assigned an appropriately licensed Service Coordinator. In order for that to happen, our Service Coordinators are responsible [...]

What is the Medically Dependent Children’s Program (MDCP) Waiver?

If you have STAR Kids patients, there’s a chance some of them receive the Medically Dependent Children’s Program (MDCP) waiver, which is a home and community based services program. The goal of this program is to support families and children by preventing institutionalization and hospitalization, while helping them remain safely in their homes with the appropriate services. Examples of these services include flexible family support service, respite, minor home modifications, adaptive aids, transition assistance services, employment assistance, supported employment, [...]

Dr. Katy Ostermaier joins Texas Children’s Health Plan as Medical Director for STAR Kids

This past fall, Texas Children’s Health Plan was thrilled to welcome Dr. Katy Ostermaier as the new Medical Director for STAR Kids. Dr. Ostermaier joins us from Texas Children’s Hospital, where she started the Special Needs Primary Care Clinic and served as the Clinic Chief for the Spina Bifida Clinic and the Down Syndrome Clinic. She completed medical school and her pediatric residency at Baylor College of Medicine, where she joined the faculty after completing her training. Dr. Ostermaier [...]

Provider Alert! STAR Kids Billing Requirements

Attention: STAR Kids Providers REMINDER: STAR Kids Billing Requirements   As previously communicated, Texas Children’s Health Plan (TCHP) requires all STAR Kids providers billing for private duty nursing (PDN) services with the T1000 CPT code to use the billing matrix available on the Texas Health and Human Services website at https://hhs.texas.gov/laws-regulations/handbooks/star-kids-handbook/appendices/appendix-iii-ltss-billing-matrix-crosswalk. This requirement was effective June 5, 2017.   Failure to use this billing matrix, including placement of modifiers, will result in denials for incorrectly billed services.  Providers may receive line denials if [...]

Provider Alert! Adoption Assistance

Subject: Adoption Assistance Attention all Texas Children’s Health Plan providers: Effective 09/01/2017 Adoption Assistance members are required to enroll in managed Medicaid and will be new members with Texas Children’s Health Plan STAR or STAR Kids programs. For Continuity of Care, Texas Children’s Health Plan will receive authorizations from TMHP for Adoption Assistance services on Texas Children’s Health Plan members, effective September 1, 2017. Texas Children’s Health Plan will honor all existing authorizations until expiration or end of 90 days after [...]

Updated STAR Kids billing matrix effective June 5, 2017.

Updated STAR Kids billing matrix effective June 5, 2017. Updates include: Registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000 Billing codes for PDN independently enrolled LVNs and RNs are included in the matrix Revenue code 663 was added to the out-of-home respite codes. Please note that failure to use this billing matrix will result in denials for incorrectly billed services. For more information on this topic, visit http://www.texaschildrenshealthplan.org/for-providers .

Provider Alert! Authorization Extension for STAR Kids Members (Revised)

The Health and Human Services Commission (HHSC) expects managed care organizations to extend longterm services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In compliance with HHSC’s guidance and as required by the STAR Kids contract, STAR Kids managed care organizations must assess each enrolled member by completing the STAR Kids Screening and [...]

Provider Alert! New Fax Number for STAR Kids Private Duty Nursing Prior Authorization

Attention STAR Kids Providers Texas Children’s Health Plan New Fax Number for STAR Kids Private Duty Nursing Prior Authorization To expedite the prior authorization process for Texas Children’s Health Plan for STAR Kids, please begin faxing to 346-232-4757 for outpatient prior authorization for the following service. Private Duty Nursing The Prior Authorization Request Form is conveniently located on the STAR Kids website at http://www.texaschildrenshealthplan.org/sites/default/files/pdf/20150410_Standard%20Prior%20Auth%20Form.pdf. Please contact your dedicated Provider Service Representative toll-free at 1-800-731-8527 with any questions. Thank you for your commitment to your Texas Children’s [...]

Provider Alert! STAR Kids Billing Matrix

Attention STAR Kids Providers Effective 06/05/2017 Updated STAR Kids Billing Matrix The STAR Kids billing matrix has been updated to include the registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000. Additionally, the billing codes for PDN independently enrolled LVNs and RNs have been added to the matrix. The Revenue Code 663 was added to the Out-of-Home Respite codes. This billing matrix will become effective for dates of service June 5, 2017 and forward. Failure to use [...]