All Providers rendering Long-Term Services and Support (LTSS), with the exception of Atypical Providers,1 are required to use the CMS 1500 Claim Form or the HIPAA 837 Professional Transaction when billing.
Providers should bill and report LTSS in compliance with the STAR Kids Billing Matrix (Matrix). Billing Matrix is located on the tab titled, STAR Kids LTSS Billing Matrix.
STAR Kids LTSS Billing Matrix
Providers billing electronically will comply with HIPAA 837 guidelines including the accurate and complete conveyance of information pertaining to the Provider(s) involved in the service event.
Atypical Providers will submit appropriate documentation to the MCO. The MCO must obtain sufficient documentation from the Atypical Provider to accurately populate a 837 professional encounter. Please refer to the HIPAA-compliant 837 Professional Combined Implementation Guide and the 837 Professional Companion Guide for further information. (See "Claims Processing Requirements" in Chapter 2, Claims, in the UMCM.)
LTSS Providers must use the "designated position" of the modifiers as indicated on the Matrix when filing claims.
- Nursing Facilities services pertaining to a member entering a Nursing Facility will be filed (paper or electronic) through the State's Claims Administrator under Traditional Medicaid (Fee for Service) following the claims submission guidelines applicable to Traditional Medicaid billing.
- Nursing Facilities services that do not involve a member entering a Nursing Facility (i.e. Respite Care) will conform to normal LTSS billing procedures.
1 Atypical Providers are LTSS providers that render non-health or non-medical services to STAR+PLUS Members. Examples include pest control services and building and supply services.