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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 6 NorthSTAR Program

Behavioral health providers that practice in the Dallas SA must be enrolled as a network provider in the NorthSTAR BHO to be reimbursed for services provided to STAR and STAR+PLUS clients.
Behavioral health providers that render services to clients in services areas other than the Dallas service area must enroll with each MCO to be reimbursed for services rendered to Medicaid managed care clients. Although managed care clients may self-refer for behavioral health services, providers should contact the client’s MCO for specific in-network requirements.
NorthSTAR provides behavioral health services (mental health, chemical dependency, and substance abuse treatment) for Medicaid clients who are enrolled in a BHO in the Dallas service area. NorthSTAR also serves a clinically and financially eligible non-Medicaid population.
NorthSTAR is known as a behavioral health carve-out of the STAR and STAR+PLUS Programs in the Dallas SA. Medicaid provides access to physical health care while NorthSTAR provides mental health and chemical dependency (behavioral health) services.
NorthSTAR provides easier access to a comprehensive array of behavioral health services and providers. The program’s goal is to provide clinically necessary behavioral health services to enrollees, through a network of qualified and credentialed providers.
In the NorthSTAR Program, ValueOptions is the sole BHO and is responsible for contracting with providers and maintaining a behavioral health-care provider delivery network. The BHO also:
In the STAR and STAR+PLUS Programs, clients select a PCP from among the providers who have contracted with a STAR or STAR+PLUS MCO. In the NorthSTAR Program, a client may have several different providers for different specialty behavioral health services. The BHO will arrange behavioral health services and make referrals to specific providers within the BHO network.
Providers are encouraged to coordinate care with physical health providers in the Medicaid managed care and Texas Medicaid fee-for-service programs. Behavioral health providers may do this by notifying the Medicaid managed care or Texas Medicaid fee-for-service provider. Behavioral health providers may also notify the BHO that the client is receiving services.
Providers interested in becoming a ValueOptions network provider can obtain additional information by contacting ValueOptions at 1‑888‑800‑6799.
If a behavioral health provider practices in the Dallas SA, he must be enrolled as a network provider in the NorthSTAR BHO (ValueOptions) to provide services to NorthSTAR enrollees. Providers who serve NorthSTAR enrollees without being in the provider network or without prior authorization in nonemergency situations risk non-payment of claims.

Texas Medicaid & Healthcare Partnership
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