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2012 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 6. STAR Health Program : 6.3 STAR Health Program Benefits

6.3 STAR Health Program Benefits
STAR Health Program clients receive all the benefits of traditional Texas Medicaid as well as service coordination to assist in making appointments and accessing services; and service management to assist with managing the health care of those with ongoing and serious medical needs.
Refer to:
Appendix B: Vendor Drug Program (Vol. 1, General Information) for information about outpatient prescription drugs.
Most Medicaid foster care claims are capitated services and must be submitted to Superior HealthPlan. The following services are non-capitated services that are paid by TMHP:
Audiology services and hearing aids for members through hearing services for children (hearing screening services are provided through the THSteps Program and are capitated)
All THSteps dental, medical, vision, and mental health providers should submit claims for services rendered to foster care clients to Superior HealthPlan’s dental, vision, and mental health contractors.
For general provider information, contact STAR Health at 1-866-439-2042.
For authorizations, contact:
(Fax 1-800-690-7030)
Integrated Mental Health Services (IMHS)
Behavioral Health authorizations:
(Fax 1-866-534-5958)
(Fax 1-252-451-2140)
Prior authorization has to be requested in writing to the following address:
Delta Dental State Government Programs
PO Box 537030
Sacramento, CA. 95853
Emergency prior authorization may be requested by phone at 1-866-287-3252.
HIPP program clients who are enrolled in STAR HEALTH should be removed from the HIPP program and continue to receive their benefits under the STAR Health program.
Refer to:
Subsection 4.14, “Health Insurance Premium Payment (HIPP) Program” in Section 4, “Client Eligibility” (Vol. 1, General Information), for more information about outpatient prescription drugs that are provided by VDP contracted pharmacies.
Appendix B: Vendor Drug Program (Vol. 1, General Information) for information about VDP.

Texas Medicaid & Healthcare Partnership
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