STAR Health Personal Care Services: T1019 Claims Denials
Date: 01/12/22
The Texas Health and Human Services Commission (HHSC) has published the updated Electronic Visit Verification (EVV) Service Bill Codes Table that provides current billing codes and details for EVV-relevant services. A discrepancy was identified in the EVV Service Bill Codes Table for STAR Health procedural and billing modifier combinations, causing billed claims to be denied. The EVV Service Bill Codes Table to reflect the appropriate service billing combinations for STAR Health has been updated as of December 17, 2021.
To review the latest version, please review the EVV Service Bill Codes Table - version 9.6, found on the HHSC EVV webpage.
ACTION NEEDED FOR DENIED CLAIMS for service dates January 1, 2021 to current:
- Providers should perform visit maintenance (VM) on all impacted claims that denied.
- Modifiers must be updated to reflect the following appropriate combination of codes for the applicable service in the vendor system and the Texas Medicaid and Healthcare Partnership (TMHP) aggregator:
- REQUIRED procedure and modifier combinations:
- New service combination T1019 UA (PCS BH Condition - Agency Model)
- New service combination T1019 U7 (PCS - CDS Model)
- New service combination T1019 UB (PCS BH Condition - CDS Model)
- REQUIRED procedure and modifier combinations:
- Claims must be rebilled to TMHP using the required service code and modifier combination.
- Visit maintenance and re-submission of corrected claims with the appropriate code/modifier combination MUST BE RECEIVED NO LATER THAN APRIL 15, 2022 for payment consideration.
For questions or additional information, please contact Superior HealthPlan at AM.LTSS@SuperiorHealthPlan.com.