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Timely Filing Override for Claims Impacted by TMHP Datalogic Eligibility Verification Issue

Date: 06/15/22

Due to an issue on how Electronic Visit Verification (EVV) vendor, DataLogic, is setup with the Texas Medicaid & Healthcare Partnership (TMHP) system, they are not able to retrieve Member Eligibility Verification for MCO-only Acute Care Superior HealthPlan Medicaid (STAR Health, STAR Kids, STAR+PLUS) and STAR+PLUS Medicare Medicaid Plan (MMP) members from TMHP. This issue caused certain EVV visits for these members to Fail to Export (FTE) from the DataLogic Vesta system and not transmit to the TMHP EVV Aggregator for processing.

TMHP has identified the root cause and is working with DataLogic to implement a long-term solution. In the interim, TMHP has instructed DataLogic to bypass the FTE edit on these visits so that the EVV visits can be exported to the EVV Aggregator for processing. Please note:

  • The EVV Aggregator will only accept the visits if they pass all the required edits, including Member Eligibility Verification check.
  • Impacted EVV visits within 95 Days from their visit date have already been exported to the EVV Aggregator for processing.
  • Additionally, Texas Health and Human Services (HHS) has provided approval for DataLogic to bypass the FTE edit on visits beyond the 95-Day visit maintenance time frame. This includes visits with dates of service between October 27, 2020 through June 30, 2021.

Claims submitted for these EVV visits may be outside of the MCO’s timely filing deadline. HHS has requested Superior to waive the timely filing deadline requirement for these impacted claims, since the issue causing the EVV visits not to be exported to the EVV Aggregator was

outside of the provider’s control. HHS has set a deadline for this process. To have the timely filing requirement waived by Superior, providers must submit these impacted claims by September 19, 2022.

For questions or additional information, please contact AM.LTSS@SuperiorHealthPlan.com.