In April 2008, the Texas Health and Human Services Commission launched STAR Health, a new health-care program to improve services and better coordinate care for children in foster care.

Contents:

• Claim submission
• Form Samples

Resources:

• Health and Human Services Commission notice
• Department of Family and Protective Services (DFPS)

When children are taken into state conservatorship they will be issued either:

• Temporary Medicaid Eligibility Verification ID card (Form 1027-A)
• Designation of Medical Consenter for non-DFPS Employee (Form 2085-B)
• Designation of Medical Consenter for DFPS Employee (Form 2085-C)

These forms will include either a Medicaid ID number or a Texas Department of Family and Protective Services (DFPS) number. Pharmacies will be allowed to submit prescription claims with the DFPS number immediately, without having to wait for a Medicaid ID to be assigned. After the child receives a Medicaid number, pharmacies must submit subsequent claims using the Medicaid ID and not the DFPS number.

Claim submission
When transmitting claims, pharmacies should submit the following values to indicate that they are using the DFPS number:

• Enter the DFPS number in "Cardholder ID" (Field 3Ø2-C2). The DFPS number is a total of 16 digits long, including leading zeros followed by 6 to 8 digits.
• Enter "8" in "Prior Authorization Type Code" (Field 461-EU).
• Enter "1Ø27" in "Prior Authorization Number Submitted" (Field 462-EV).

Failure to submit those values will result in a rejection.
Standard claim submission procedures should be followed when submitting a claim with the Medicaid ID. Full payer sheets for the Vendor Drug Program are available in the Pharmacy Provider Procedure Manual.
These instructions are available to download. We encourage you to post these instructions in your pharmacy for reference and to reproduce this information for staff education.