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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 3 STAR Program : 3.2 STAR Client Enrollment : 3.2.1 Expedited Enrollment of Pregnant Women (Program Type 40)

3.2.1
A pregnant woman who applies for program type 40 has 16 days from the date of application to choose a STAR MCO. If she does not choose a STAR MCO, one will be chosen for her.
The Enrollment Broker contacts the client to begin the enrollment process and assists the client in selecting an MCO. The client may also contact the Enrollment Broker directly at 1‑800‑964‑2777 (STAR Help Line). To protect continuity of care and client choice, the Enrollment Broker will work with each pregnant woman to select a health plan that includes her current prenatal care provider or to choose an obstetrical care provider that meets her needs.
Clients will be covered under Texas Medicaid fee-for-service until their Medicaid MCO coverage begins. To ensure proper billing, providers should call the Enrollment Broker at 1‑800‑964‑2777 (STAR Help Line) to obtain the name of the client’s health plan. However, client eligibility should always be verified at the time the service is to be rendered.
Women certified as Medicaid program type 40 may be retroactively enrolled in STAR. Women who are certified as Medicaid program type 40 on or before the 10th of the month will be enrolled in STAR beginning the first of the month of certification. Those who are certified after the 10th of the month will be on Texas Medicaid fee-for-service the month of certification and will be enrolled in STAR beginning the first of the month following the month of certification.
There are two exceptions to this rule:
Women who are certified at any time in their actual month of delivery (if known by HHSC before certification) will be enrolled in STAR the first of the following month (prospective enrollment).
Important:
The following examples show when benefits begin in relation to certification:
 
 
 
Within 14 days of enrolling in an MCO, a plan representative will contact the new client to help arrange the first prenatal appointment. Providers should also expect contact from the health plans to facilitate prenatal appointments for new clients. Physicians and other prenatal care providers are encouraged to make prenatal appointments within two weeks.
Note:

Texas Medicaid & Healthcare Partnership
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