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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 20, 2026
Summary
Texas is implementing Phase II of the Integrated Dual Special Needs Plans (D-SNP) model effective January 1, 2027, requiring additional STAR+PLUS managed care organizations to begin operating Integrated D-SNPs in five counties (Bexar, Dallas, El Paso, Harris, and Hidalgo). Billing teams must update EVV system plan codes and create new authorizations for dual-eligible members who transition to different MCOs, and submit claims to the new payers for dates of service on or after January 1, 2027.
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What to do
by Dec 31, 2026 · 3 steps
01Billing team, program providers, FMSAs, and PSOs must (1) identify which dual-eligible members are transitioning to different STAR+PLUS MCOs operating Integrated D-SNPs using the C21/SAVERR-based TMC EV, 270/271 eligibility inquiry, or EaaS/TIERS-based Medicaid Client Portal; (2) create new authorizations in the EVV system using the new MCO's plan code and applicable information from current authorizations; (3) manually enter dual-eligible members' new STAR+PLUS authorizations into the EVV system.
02Starting January 1, 2027: Update MCO payer plan codes in EVV for transitioned members and bill the new payer for all dates of service on or after January 1, 2027.
03If using a third-party billing vendor, notify them of MCO and plan code changes.
If missed: Failure to update plan codes and create new 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.