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EVV Impacts due to Medicare–Medicaid Plans (MMPs) Pilot Program Non-Renewing in Select Service Areas, Effective Jan. 1, 2025

Effective Jan. 1, 2025, the MMPs Pilot Program will no longer be available in select service areas.

Wellpoint and Superior will end MMP operations on Dec. 31, 2024, *only* in the following services areas:

*Plan Name*



*Service Area*



*Plan Code*



Wellpoint Texas, Inc



El Paso MMP



3G



Wellpoint Texas, Inc



Bexar MMP



4F



Superior Health Plan



Bexar MMP



4H



Wellpoint Texas, Inc



Tarrant MMP



6F



Wellpoint Texas, Inc



Harris MMP



7Z



 

The MMP members received a notice from their managed care organization (MCO) stating that it is no longer participating in the MMP program. The notice provided the members with options to transition their coverage.

To determine which option the member chose, program providers and financial management services agencies (FMSAs) can check the member’s eligibility using the following:


* The *EaaS/TIERS-based* 270/271 or Medicaid Client Portal supports eligibility inquiry for future dates up to the end of the following month. Providers can use this to check eligibility.
* The *C21/SAVERR-based* TMC EV and 270/271 eligibility inquiry is limited to access only current month eligibility information.

 

Program providers, FMSAs, and Proprietary System Operators (PSOs) should create a new authorization if the member’s payer information has been received from their new MCOs.

Once they receive a new authorization for their members, it must be manually added into their EVV system.

If the program provider, FMSA, and PSO do not have the current authorization from the new MCO, they can use the information from the eligibility portals cited above to input in their EVV system.

*Payment of Services as of Jan. 1, 2025*

EVV claims for EVV required services must be submitted to the Texas Medicaid & Healthcare Partnership (TMHP). Program providers and FMSAs using a third-party resource for billing need to notify the third-party entity about any changes in MCO contracts.

For more information about the MMP transition, contact HHSC EVV Operations <[email protected]>.









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