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Billing

We try to make the billing process as easy and seamless as possible. And we’re always working to improve the ways we work with you. This page covers key topics about billing, like filing and copays.

Questions?

Need more info about billing? Just check your provider manual. Or contact us.

Filing

 

For filing, you have 95 days from the date of service or within 95 days of the Explanation of Benefits (EOB) for Coordination of Benefits (COB).

 

Copays

 

In most cases, members don’t have copays for covered services. Children’s Health Insurance Program (CHIP) members have copays for covered services unless they have CHIP Perinatal coverage.

 

Billing STAR members

 

Don’t bill members for Medicaid-covered services — unless the Medicaid benefit description says the member needs to make a payment. Also, don’t “balance bill” or take recourse against members for denied or reduced claims for services that are within the amount, duration and scope of STAR benefits.

 

Billing CHIP members

 

Don’t bill members for CHIP-covered services (other than copays) — unless the CHIP benefit description says the member needs to make a payment. Also, don’t “balance bill” or take recourse against members for denied or reduced claims for services that are within the amount, duration and scope of CHIP benefits.

 

Copays

 

You’re responsible for collecting any CHIP copayments at the time of service, according to CHIP cost-sharing limits. This is the only amount you can collect from CHIP members. The exception is costs for unauthorized non-emergent services provided to a member by out-of-network providers for non-covered services.

 

CHIP Perinatal members have no copays for covered services.

 

Special billing for newborns

 

It can take several weeks to process a newborn’s member ID card after enrollment. You can use their mother’s ID card when providing care to the newborn until they get their own ID. Just call us if the newborn hasn’t received an ID card after 31 days of enrollment:

 

 

Out-of-network care 

 

Texas STAR or CHIP members may choose to get services:

 

  • From a provider outside their network
  • That don’t have authorization
  • That aren’t a covered benefit

If they choose to get services out of network, they must sign a private pay agreement and a member acknowledgment form.

 

Private pay agreement (PDF)

 

Member acknowledgment form (PDF)

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