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Mental Health Targeted Case Management and Mental Health Rehabilitation Services Claims to Be Forwarded to the Client’s MCO in Dallas Service Area

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Effective November 1, 2021, there will be a change to claims submitted to TMHP for mental health targeted case management (MHTCM) and mental health rehabilitation (MHR) services provided to STAR and STAR+PLUS clients in the Dallas service area. This change applies to claims submitted by local mental health authorities (LMHAs), local behavioral health authorities (LBHA), and private providers of these services. These claims will be forwarded to the client’s Medicaid managed care organization (MCO) for payment. Currently, claims for mental health targeted case management (MHTCM) and MHR services are paid by the Texas Medicaid & Healthcare Partnership (TMHP) for STAR and STAR+PLUS clients in the Dallas service area.

This change applies to all STAR and STAR+PLUS enrolled clients in the Dallas service area, including clients residing in nursing facilities or intermediate care facilities.

The change does not apply to Medicaid-qualified Medicare beneficiaries who are enrolled in STAR+PLUS because their MHTCM and MHR services are carved out of managed care and payable by TMHP.

Note: Persons enrolled in a STAR+PLUS Medicare-Medicaid Plan (MMP) have their MHTCM/MHR services paid by their MCO. 

Important: Claims submitted with modifier HZ (justice-involved) must be submitted to TMHP because these claims are not payable by the MCO. Providers can refer to Section 5, “Intellectual Disability Service Coordination, Mental Health Targeted Case Management, and Mental Health Rehabilitation Services,” of the Behavioral Health and Case Management Services Handbook and Section 8, “Carve-Out Services,” of the Medicaid Managed Care Handbook.

These changes to claims processing will affect the following MCOs:

Managed Care

Amerigroup Texas Inc.

Molina Healthcare of Texas

Parkland Community Health Plan

Superior HealthPlan

Providers can also contact their clients’ MCOs for additional MHTCM and MHR billing information.

For more information, call the TMHP Contact Center at 800-925-9126.