With the implementation of EVV for the Home Health Care Services on January 1, 2024, MCOs brought forth concerns regarding the program provider or financial management services agency (FMSA) billing EVV services as secondary insurance claims.

MCOs informed HHSC that a reason for denial is needed from the program provider or FMSA and that some MCOs require an Explanation of Benefit (EOB) as an attachment for these types of denials.

Key Details:

Program providers and FMSAs use TexMedConnect to bill their claims. Currently, TexMedConnect does not support electronic attachments, and there are no future updates planned for TexMedConnect; therefore, program providers and FMSAs are not able to attach the EOBs.

TexMedConnect does allow program providers and FMSAs to enter other health insurance information in the designated fields.

Program providers and FMSAs are to use the TexMedConnect Acute User Guide and follow the instructions on the tab, other-insurance / submit claim.

Community First Resources:



2.0 Uniform Managed Care Manual Claims Manual (PDF): When a service is billed to a third-party insurance resource other than the MCO, the Claim must be refiled and received by the MCO within 95 Days from the date of disposition by the other insurance resource. The MCO will determine, as a part of its provider Claims’ filing requirements, the documentation required when a program provider refiles these types of Claims with the MCO. 

TexMedConnect Acute User Guide (tmhp.com)

Next steps for Providers: 

Providers should share this communication with their staff.


Email ProviderRelations@cfhp.com or call 210-358-6294.

Beginning September 1, 2024 Community First Health Plans, Inc. will be adding STAR+PLUS to its line of health care products.

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