The STAR+PLUS and STAR Kids Long-term Services and Supports (LTSS) Healthcare Common Procedure Coding System (HCPCS) codes, modifiers, and unit types for Electronic Visit Verification (EVV) required services have been updated. These updates also impact STAR Health because the STAR Kids LTSS billing matrix is used for some STAR Health services. The updates are effective December 1, 2022.
Program providers and financial management services agencies (FMSAs) contracted with managed care organizations (MCOs) must complete the five steps listed below to help avoid visit transaction rejections and EVV claim mismatches and denials.
- Review the EVV Personal Care Services Bill Codes table updates.
- Review the Managed Care section.
- Review the 12/1/2022 Revision History.
- The table can be found in both Excel and PDF formats on the HHSC EVV web page.
- Log in to your Provider Portal to view updated service authorizations or new service authorizations for your Members. Confirm that the HCPCS codes, modifiers, and unit types are the same as the EVV Personal Care Services Bill Codes table.
- Note: MCOs may also provide updated service authorizations through other methods, such as fax. Contact Community First for more information.
- Log in to your EVV system to update existing service authorizations or create new service authorizations using the updated HCPCS codes, modifiers and unit types. Resources are listed below.
- Refer to DataLogic Vesta’s notice, “EVV Personal Care Services Bill Codes Table Updates (PDF),” under their Publication section.
- Refer to First Data AuthentiCare’s document, “Service Code List (PDF),” under their web portal’s Custom Links tab.
- EVV Proprietary System Operators (PSOs) should follow their internal procedures to update existing service authorizations or create new service authorizations.
- Before submitting a claim, use the “Accepted Visit” search tab in the EVV Portal to confirm that the visit transactions for these services have been accepted by the EVV Aggregator.
- Submit claims with dates of service on or after December 1, 2022, to TMHP using the updated HCPCS codes, modifiers, and unit types to make sure a successful EVV claims match. The claim will be forwarded to Community First.
The following are related TMHP learning management system (LMS) resources:
- Refer to, “Using the EVV Portal: Accessing the EVV Portal Job Aid,” for instructions on how to use the EVV Portal.
- Refer to, “Using the EVV Portal: Accepted Visit Search Tab Job Aid,” for instructions on how to use the Accepted Visit Search tab.
- Watch, “CBT Module 5 Part 4: Accepted Visit Search Demo,” for instructions on how to use the Accepted Visit Search tab.
For additional help, please review the Community First LTSS Billing Matrix Training Presentation.
Contact Community First with questions about this notice. Refer to our Electronic Visit Verification site for contact information.
Refer to TMHP’s notice posted on July 12, 2022 to learn more.