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7.3.3.1 STAR+PLUS Mental Health Claims
Freestanding psychiatric facility claims and inpatient claims with a behavioral health primary diagnosis submitted for clients who are enrolled in a STAR+PLUS plan will be processed by the STAR+PLUS HMOs. TMHP will deny these claims. Providers must file these types of claims with the appropriate HMO.
Note: This does not include claims for mental health case management and rehabilitative services delivered by Mental Health and Mental Rehabilitative (MHMR) facilities. Those services remain carved out of this managed care model.
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