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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 17, 2026

Summary

Texas HHSC is expanding the Integrated Dual Special Needs Plans (D-SNP) model in Phase II effective January 1, 2027, requiring additional STAR+PLUS managed care organizations to begin operating D-SNPs in five Texas counties. Billing teams must update EVV system records and payer plan codes for dual-eligible members who transition to new MCOs, and ensure claims for dates of service on or after January 1, 2027 are billed to the correct new payer with updated authorizations.

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What to do

by Dec 31, 2026 · 8 steps
01Billing team, providers, FMSAs, and PSOs must prepare for the January 1, 2027 transition by.
02Identifying which dual-eligible members will transition to different MCOs operating new Integrated D-SNPs in Bexar, Dallas, El Paso, Harris, and Hidalgo counties.
03Verifying member MCO assignments and new plan codes using the Medicaid Client Portal or 270/271 eligibility inquiry for future dates.
04Creating new authorizations in the EVV system using the updated STAR+PLUS MCO plan codes effective January 1, 2027.
05Manually entering dual-eligible members' new authorizations into the EVV system before service delivery begins.
06Beginning January 1, 2027: Billing team must ensure all claims for dual-eligible members are submitted to the new MCO payer with the correct updated plan code.
07If using third-party billing vendors, notify them of MCO and plan code changes.
08Continue submitting EVV-required services directly to TMHP for EVV claims matching.
If missed: Failure to update plan codes and authorizations will result in claims being submitted to incorrect payers and potential claim denials.

Original notice

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

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