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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 6 NorthSTAR Program : 6.3 NorthSTAR Program Benefits : 6.3.1 Hospital Billing

In the Dallas SA, SSI clients are subject to mandatory enrollment in Medicaid managed care through the NorthSTAR Program. In some instances, general acute care hospitals treat a NorthSTAR client with a primary behavioral health diagnosis. In that instance, the general acute care hospital needs to seek authorization and reimbursement from ValueOptions using the CMS‑1500 form for outpatient services and UB-04 CMS-1450 for inpatient services.

Texas Medicaid & Healthcare Partnership
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