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  • 05-13-15 Nursing Facility Services Transitioning To STARPLUS PDF

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    DEVESH BHOLE
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    When billing managed care claims through TexMedConnect for consecutive nursing facility service dates without changes in level of service or gaps in dates, providers should submit the claims as a single line item. Submitting multiple lines for consecutive dates may cause initial claim denials. For claims with gaps or changes in level of service, separate claims should be submitted to avoid processing problems. The document provides contact information for submitting claims through managed care organization portals or with questions about TexMedConnect submissions or the MCOs.

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    When billing managed care claims through TexMedConnect for consecutive nursing facility service dates without changes in level of service or gaps in dates, providers should submit the claims as a single line item. Submitting multiple lines for consecutive dates may cause initial claim denials. For claims with gaps or changes in level of service, separate claims should be submitted to avoid processing problems. The document provides contact information for submitting claims through managed care organization portals or with questions about TexMedConnect submissions or the MCOs.

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    17 views2 pages

    05-13-15 Nursing Facility Services Transitioning To STARPLUS PDF

    Uploaded by

    DEVESH BHOLE
    When billing managed care claims through TexMedConnect for consecutive nursing facility service dates without changes in level of service or gaps in dates, providers should submit the claims as a single line item. Submitting multiple lines for consecutive dates may cause initial claim denials. For claims with gaps or changes in level of service, separate claims should be submitted to avoid processing problems. The document provides contact information for submitting claims through managed care organization portals or with questions about TexMedConnect submissions or the MCOs.

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    of 2

    Nursing Facility Services Transitioning to STAR+PLUS:

    Entering Managed Care Claims with Multiple Lines on TexMedConnect


    Information posted May 13, 2015

    When billing for managed care claims with consecutive service dates without a
    change in the level of service or gap in service dates, providers must enter these
    claim transactions as one line item on the Details tab in TexMedConnect. (See
    examples below)

    Note: Entering multiple rows for consecutive service dates can result in an initial
    claim denial by the managed care organization (MCO) during processing.

    For claim transactions which include a gap in the dates of service and/or a
    change in the level of service, separate claims should be submitted to avoid
    potential processing problems.

    For questions related to TexMedConnect claim submission contact TMHP at


    1-800-626-4117, Option 1.

    Providers can submit claims with multiple lines through the MCO provider portal at:

    o Amerigroup: https://providers.amerigroup.com/pages/tx-2012.aspx
    o Cigna-HealthSpring: https://starplus.hsconnectonline.com/login.aspx

    1 of 2
    o Molina: www.molinahealthcare.com/providers/tx/medicaid/Pages/home.aspx
    o Superior: www.superiorhealthplan.com/for-providers/secure-web-portal/
    o United Healthcare: www.unitedhealthcareonline.com

    For questions related to MCO Portal submission contact the appropriate MCO Provider
    Service Representative:

    a. Amerigroup: txstarprovider@amerigroup.com or 1-866-696-0710


    b. Cigna: 1-877-653-0331
    c. Molina: 1-855-322-4080
    d. United: 1-877-842-3210
    e. Superior: 1-877-391-5921

    2 of 2

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