Claims process change for Texas STAR Kids (Medicaid) members with Medicare benefits
Effective April 1, 2022, we’re changing the way we process claims for STAR Kids (Medicaid) members with Medicare benefits in Texas.
Please review the claims submission process below to ensure accurate claims processing and prevent future claim denials. Please note that the process for billing members with commercial coverage as primary is not affected by these changes.
How to bill and avoid claim denials:
Bill Medicare first (primary payor) for Medicare-eligible services
After receiving your Provider Remittance Advice (PRA), for the services listed below, please bill the remaining balance directly to Texas Medicaid & Healthcare Partnership (TMHP) for secondary payment:
Durable medical equipment and supplies
Hospital - outpatient
Lab, x-ray and radiology
Acute Therapies - physical, occupational and speech
Organ and tissue transplantation
Inpatient facility services
Long-term services and supports listed below meet outpatient exemptions are not Medicare-covered services. Please bill them to UnitedHealthcare for primary payment.
Minor home modifications
Private duty nursing
Therapies - physical, occupational and speech (provided under the Comprehensive Care Program (CCP))
Respite care/flexible family support
Employment assistance/supported employment
In-home habilitation (Community First Choice)
When and how to submit an appeal If you submit a secondary claim to UnitedHealthcare, are denied and believe UnitedHealthcare is the proper secondary payor, you can appeal.
For information about filing an appeal, go to UHCprovider.com/TXcommunityplan > Care Provider Manuals > Texas > UnitedHealthcare Community Plan of Texas STAR Kids Administrative Guide / Care Provider Manual.
Additional resources Texas Medicaid Provider Procedures Manual: Go to tmhp.com > Medicaid Provider Manual > Texas Medicaid Provider Procedures Manual.
For help submitting claims to TMHP: Go to tmhp.com > Medicaid Provider Manual > Texas Medicaid Provider Procedures Manual > Individual Chapters PDF > Volume 1, Section 6: Claims Filing. You can also call the TMHP Contact Center General Inquiries Line at 800-925- 9126.
Please call Customer Service at 888-887-9003, 8 a.m.–6 p.m. CT, Monday– Friday.