Billing EVV Services as Secondary Insurance Claims

Date: March 26, 2024

Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers

Call to action: Texas Children’s Health Plan (TCHP) would like to share updates to the process of billing secondary insurance for program providers and financial management services agencies (FMSAs).

With the implementation of EVV for the Home Health Care Services on January 1, 2024, concerns were brought forward regarding the billing EVV services as secondary insurance claims. Specifically, it was shared that a reason for denial is needed from the program provider or FMSA and that some MCOs require an Explanation of Benefit (EOB) as attachment for these types of denials.

Currently, TexMedConnect does not support electronic attachments and there are no future updates planned for TexMedConnect; therefore, program providers and FMSAs are not able to attach the EOBs.

However, TexMedConnect does allow program providers and FMSAs to enter other health insurance information in the designated fields.

Next steps for providers: Program providers and FMSAs are to use the TexMedConnect Acute User Guide and follow the instructions on the tab other-insurance / submit claim.

Resources:

2.0 Uniform Managed Care Manual Claims Manual (PDF): When a service is billed to a third-party insurance resource other than TCHP, the Claim must be refiled and received by TCHP within 95 Days from the date of disposition by the other insurance resource. TCHP will determine, as a part of its provider Claims’ filing requirements, the documentation required when a program provider refiles these types of Claims with TCHP. 

TexMedConnect Acute User Guide (tmhp.com)

Next steps for providers: Providers are encouraged to share this communication with their staff.

If you have any questions, please email Provider Relations at:providerrelations@texaschildrens.org.

For access to all Provider Alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.