Billing EVV Services as Secondary Insurance Claims

Date: 04/10/24

Electronic Visit Verification (EVV) was implemented for Home Health Care Services on January 1, 2024. This change recently brought forth additional clarification regarding program providers or Financial Management Services Agencies (FMSAs) billing EVV services as secondary insurance claims.

The Managed Care Organizations (MCOs) informed Texas the Health and Human Services Commission (HHSC) that a reason for denial is needed from the program provider or FMSA, and that some MCOs require an Explanation of Benefit (EOB) as an attachment for denials related to secondary insurance.

Program providers and FMSAs use TexMedConnect to bill their claims. Currently, TexMedConnect does not support electronic attachments and there are no future updates planned for TexMedConnect, therefore program providers and FMSAs are not able to attach the EOBs.

TexMedConnect does allow program providers and FMSAs to enter other health insurance information in the designated fields. Program providers and FMSAs should follow the instructions in the “Other-Insurance/Submit Claim Tab” section of the Texas Medicaid & Healthcare Partnership TexMedConnect Acute User Guide (PDF).

Superior HealthPlan requires EOBs to be included with the claim when other insurance is denied. Providers can submit these claims:

• Electronically though Superior’s Secure Provider Portal and attach the EOB document after the claim is submitted.
• Electronically through a clearinghouse.
• On paper.

When a service is billed to a third party insurance resource other than to Superior, the claim must be refiled and received by Superior within 95 Days from the date of disposition by the other insurance resource. Superior will determine, as a part of its provider claims filing requirements, the documentation required when a program provider refiles these types of claims.

For questions or additional information, email Superior’s LTSS Account Management team at AM.LTSS@SuperiorHealthPlan.com.