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Texas MedicaidMedicare Advantage · Administrative · General · TXHigh impact

EVV Impacts due to Dual Integration Project, Phase II effective Jan. 1, 2027

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 15, 2026

Summary

Texas HHSC is expanding Integrated Dual Special Needs Plans (D-SNPs) in Phase II effective January 1, 2027. Additional STAR+PLUS managed care organizations will begin operating Integrated D-SNPs in five Texas counties. Billing teams must update EVV system records with new MCO plan codes and bill new payers for dates of service on or after January 1, 2027, when dual eligible members transition to different MCOs.

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What to do

by Dec 31, 2026 · 10 steps
01Billing team, FMSAs, and program providers must prepare for MCO transitions.
02Beginning January 1, 2027.
03Identify which dual eligible members have transitioned to a different STAR+PLUS MCO operating an Integrated D-SNP using the new plan codes listed in the policy (Bexar: S1, S5; Dallas: S6; El Paso: S2; Harris: S3; Hidalgo: S7).
04Create new authorizations in the EVV system with the new MCO plan code and applicable information from prior authorizations.
05Manually enter dual eligible members' new STAR+PLUS authorizations into the EVV system.
06Bill the new MCO payer with dates of service on or after January 1, 2027.
07If using a third-party billing vendor, notify them of the MCO and plan code changes.
08Verify member eligibility and current MCO assignment using EaaS/TIERS-based 270/271 or Medicaid Client Portal (supports future-date eligibility inquiry through end of following month).
09Failure to update payer plan codes and bill the correct MCO will result in claims denial or improper routing.
10Continue submitting EVV Required services claims directly to TMHP for EVV claims matching.

Original notice

EVV Impacts due to Dual Integration Project, Phase II effective Jan. 1, 2027
tmhp.com · Always check the source before changing claims.
View original ↗

Related changes

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EVV Impacts Due to Dual Integration Project Phase II, Effective Jan. 1, 2027HighEffective Jan 1, 2027 · GeneralEVV Impacts due to Dual Integration Project, Phase II effective Jan. 1, 2027HighEffective Jan 1, 2027 · GeneralBrowse every Texas Medicaid change in the policy list

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