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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 6 NorthSTAR Program : 6.3 NorthSTAR Program Benefits : 6.3.3 Prior Authorization Requirements

To receive payment for services provided to ValueOptions clients, providers must be enrolled with ValueOptions. (Exceptions include emergency care and medically necessary treatment episodes that began before the client joined NorthSTAR.) ValueOptions requires that the provider obtain prior authorization for most nonemergency services. If the provider does not obtain prior authorization, they may not get payment for services. These rules apply whether the provider’s practice or facility is located in or out of the Dallas SA.
Expedited enrollments of pregnant women (program type 40) into the STAR Program may be retroactive; and NorthSTAR has enrollment that is retroactive to the NorthSTAR eligibility certification date.

Texas Medicaid & Healthcare Partnership
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