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2012 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 6. STAR Health Program : 6.3 STAR Health Program Benefits : 6.3.1 STAR Health Mental Health Rehabilitation Mental Health Claims Submissions

6.3.1
STAR Health providers must submit their mental health rehabilitation claims for Superior HealthPlan foster care clients to IMHS at the following address:
IMHS Claims
PO Box 6300
Farmington, MO 63640‑3806
Providers should submit their electronic claims to one of the clearinghouses that are trading partners with IMHS. Information about these clearinghouses can be found on the Cenpatico website at www.cenpatico.com. Click Providers, click Resources, and then click Electronic Transactions (EDI). Texas mental health providers can use Emdeon or Availity with Payer ID 68053 (Texas only).
For more information on the use of other clearinghouses, providers should call IMHS at 1‑877‑730‑2117 or visit the Cenpatico website at www.cenpatico.com.
The following procedure codes and modifier combinations must be submitted to IMHS for mental health rehabilitation services:
The services listed above may be reimbursed when rendered to clients who satisfy the criteria of the mental health, priority population and who are determined to need inpatient rehabilitation. These services may be provided to a person with a single severe mental disorder (excluding mental retardation, pervasive developmental disorder, or substance use disorder) or a combination of severe mental disorders as defined in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).

Texas Medicaid & Healthcare Partnership
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