Provider Alert! Clarification for the STAR Kids LTSS Billing Matrix Revisions

Date: June 6, 2022                        

Attention: STAR Kids Providers

Effective date: December 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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.

TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons.

Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org.

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of the new effective date for the revised LTSS billing matrix. Health and Human Services Commission (HHSC) is delaying the implementation date for the revised LTSS Billing Matrix to December 1, 2022. This new implementation date was coordinated with the HHSC Electronic Visit Verification (EVV) team and ensures MCOs and Medicare-Medicaid Plans (MMP)s adequate lead time to make appropriate system changes. HHSC plans to post the final matrices on June 1, 2022. A policy update memo and gov delivery notice will accompany this announcement.

Update 6/1/2022: STAR Kids LTSS Billing Matrix and Crosswalk

How this impacts providers: HHSC provides the following clarification. HHSC published A STAR Kids LTSS Billing Matrix in March 2022 to comply with the National correct coding Initiative (NCCI) requirements. MCOs and financial management services agencies (FMSAs) provided feedback on the March 2022 revised billing matrices, which necessitated additional changes to the matrix. Therefore, all MCOs and MMPs must postpone any NCCI-related system changes until further notice.

MCOs and MMPs must use the code and modifier combinations without the NCCI-related edits in the LTSS matrices published to the website on April 11, 2022. The STAR Kids, Appendix III, LTSS Billing Matrix and Crosswalk, files have been replaced with a version dated April 2022, effective immediately. MCOs, MMPs, and providers must use the April 2022 matrix until further notice.

STAR Kids Handbook Policy Updates: https://www.hhs.texas.gov/handbooks/star-kids-handbook/hhsc-policy-updates

Next steps for providers: Providers should share this communication with their staff.

This is a clarification of prior guidance that was previously published, http://www.thecheckup.org/2022/04/20/provider-alert-star-kids-long-term-services-and-supports-billing-matrix-revisions/.

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