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7.4.5 Claims Filing Information
All behavioral health claims for NorthSTAR enrollees in the Dallas SA must be filed to the NorthSTAR BHO, ValueOptions. Behavioral health specialists and hospitals are not to bill TMHP for behavioral health services provided to clients who are enrolled in or eligible for enrollment in the NorthSTAR Program.
Exception: Claims with a primary diagnosis of developmental disability (mental retardation, autism, pervasive developmental disorder) are submitted to TMHP.
If a behavioral health claim is submitted to TMHP for any diagnosis other than a developmental disabilty, it is denied. If it is paid erroneously, TMHP recoups it later.
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