Provider Newsletter Fall • 2026 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Salem, OR Permit No. 86 Beginning Jan. 1, 2027, El Paso Health will introduce a new, integrated Medicare-Medicaid plan for dualeligible members (individuals eligible for both Medicare and full Medicaid). This integrated plan is designed to create a more seamless health-care experience by improving coordination across medical, behavioral health, long-term services and supports (LTSS), and pharmacy benefits. Key changes include: ■Improved coordination between Medicare and Medicaid benefits for dualeligible members. ■Streamlined processes and resources to support Providers in caring for members with complex health-care needs. ■Continued education and Provider communications leading up to implementation to ensure a smooth transition. What Providers can do to prepare: ■Verify your participation status for both El Paso Health Medicare D-SNP and Medicaid STAR+PLUS. ■Verify member eligibility to ensure claims are submitted to the appropriate line of business. ■Review updated billing and claims guidance as it becomes available. Become familiar with the integrated member ID card that dual members will begin using. Preparing for the dual integration ■Watch for upcoming Provider bulletins and training opportunities—including details on operational changes, member identification, care coordination processes, and Provider resources— that will support the transition. Over the coming months, El Paso Health will provide additional information, WHAT PROVIDERS NEED TO KNOW training opportunities, and implementation updates to help Providers prepare for the Jan. 1, 2027, effective date. We appreciate your continued partnership and commitment to delivering high-quality, continuous care to our members.
news NEW ADVANCED TECHNOLOGIES El Paso Children’s Hospital enhances pediatric care Special services for children of traveling farmworkers El Paso Health has special Medicaid services for the children of traveling farmworkers. For example, we can help schedule their upcoming Texas Health Steps exams and help them best use their vision, mental health, and transportation benefits. If you have any questions or would like more information about these services, or if you’d like us to provide an in-service training to your staff, call the Outreach Coordinator at 915-532‑3778, ext. 1075. El Paso Children’s Hospital added two advanced technologies, the Lumenis UltraPulse Laser and the Zeiss Kinevo 900, further strengthening our commitment to delivering innovative, life-changing care for children and bringing leading-edge surgical capabilities to pediatric patients close to home. Precision-based laser therapy The Lumenis UltraPulse Laser is an advanced CO₂ laser system designed to treat complex skin conditions, including scars, burns, and lesions. By delivering high-energy pulses in ultra-short durations, the technology allows deeper, more precise treatment of scar tissue while preserving surrounding healthy skin. Its ability to penetrate significantly deeper than traditional CO₂ lasers makes it particularly effective for thick scars and burn contractures. This minimally invasive technology helps remodel and soften scar tissue, improving physical function and cosmetic outcomes. For pediatric patients, these treatments can enhance mobility, reduce discomfort, and support healthier development while improving confidence and quality of life. Next-generation digital imaging El Paso Children’s Hospital expands its advanced surgical capabilities with the Zeiss Kinevo 900, a state-of-the-art platform featuring 4K, 3D imaging. The system provides enhanced clarity, color, and detail, allowing surgical teams to visualize intricate anatomy with exceptional precision during procedures. Designed to support a wide range of specialties, the Kinevo 900 helps the surgical team access high-resolution, three-dimensional views in real time. This enhances collaboration, improves workflow, and supports better surgical outcomes. By combining precision-based laser therapy with next-generation digital imaging, the hospital continues to expand access to safer, more effective, and less invasive care options. El Paso Children’s Hospital reaffirms its mission to bringing world-class innovation, compassionate care, and specialized treatment for all children. 2
Submitting a corrected claim is often the fastest and most efficient way to resolve a denial. To support timely processing and reduce avoidable delays, we want to highlight a few key reminders for corrected claims submissions. Corrected claims should be clearly identified using the appropriate frequency code, which allows our system to recognize the submission as a replacement to a previously processed claim rather than a duplicate. Providers should also reference the most recently processed claim when submitting a corrected version. This ensures the corrected claim aligns with the latest adjudicated information and prevents conflicts between multiple submissions. Timely filing and faster resolution Including all updated details—such as revised billing codes, modifiers, dates of service, or supporting documentation—helps our team review and reprocess the claim efficiently. Submitting a corrected claim rather than a new or duplicate claim also helps Initial evaluation (CPT code 97151): Submit the completed evaluation and treatment plan. For the first 90 days of treatment, a signed physician referral is also required. The referral should clearly list the recommended frequency and duration of services. 90-day extension: Please include attendance logs for both the child and the parent or caregiver, along with a brief progress summary that describes how treatment is going so far. 180-day re-evaluation: Every 180 days, a full re-evaluation and updated treatment plan are needed. Both documents must be signed and dated by the licensed behavior analyst (LBA) and by the parent or caregiver. stay informed Best practices for submitting corrected claims ABA SERVICES Keeping treatment moving without delays bridge timely filing, as corrected claims are considered part of the original claim’s life cycle. Duplicate submissions, however, may result in denials and do not extend timely filing limits. We also encourage Providers to submit a corrected claim instead of an appeal when the issue is related to coding, modifiers, or missing information. Appeals are intended for disputing an adjudication decision, while corrected claims allow the claim to be reprocessed with updated data—often resulting in faster resolution. While we cannot advise on how to bill, our Claims Department is available to explain how corrected claims adjudicate based on what is submitted. Applied behavior analysis (ABA) services are critical for Texas Medicaid members with autism spectrum disorder. To keep care running smoothly and to avoid delays in claims, please make sure the following items are submitted at each stage of treatment. Submitting these items on time helps prevent denials and keeps therapy consistent for your patients. If you have any questions about the documentation requirements, please contact our Provider Services team for direct assistance. 3
Provider Newsletter ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 1-877-532-3778, elpasohealth.com. Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 1-877-532-3778. Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP111842608 - EPH-PR-Fall 2026 Provider Newsletter 2026 © Coffey Communications, Inc. All rights reserved. resources Be ready for HEDIS in January The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the health-care industry’s most widely used performance improvement tools. The upcoming HEDIS season is scheduled to kick off in January 2027. You will be receiving official medical records requests from El Paso Health through our Provider Portal. Medical records requests are sent out to our network Providers to obtain medical records for data that has not been captured in claims. We ask that you read the request letters carefully so that you can send the required documentation. Each measure has its own specifications, so proper documentation will ensure compliance and adherence to the measure. Each year there are fewer hybrid measures, so proper documentation, coding, and billing on your part is essential. HEDIS season is changing from a seasonal event to a year-round expectation. We value you as a Provider and partner in ensuring that our members get quality care. If you have any questions regarding HEDIS, please contact the Quality Improvement Department or Provider Relations Department at 915-532-3778. Help your patients protect themselves this flu season 2026 / 2027 Value-Added Services, effective Sept. 1, 2026 We would like to inform you of the upcoming 2026 / 2027 Value-Added Services (VAS) that will become effective on Sept. 1, 2026, for our STAR, CHIP, and STAR+PLUS members. These services are designed to offer additional support to our members beyond Medicaid-covered benefits. They may include health-related items, wellness incentives, and support services tailored to the needs of each program population. To view the full list of VAS offerings, please visit the following links: ■STAR / CHIP: www.elpasohealth.com/27newflyer ■STAR+PLUS: www.elpasohealth.com/27newspflyer Please note that all El Paso Health members have been notified of the 2026 / 2027 VAS. We encourage you to review the information to familiarize yourself with the new offerings, as they may enhance the care and support you provide to your patients. We appreciate your continued partnership and dedication to the health and well-being of our members. If you have any questions regarding this communication, please contact our Provider Relations team at 915-532-3778 or email us at ProviderRelationsDG@elpasohealth.com. Staying healthy matters, and El Paso Health wants our members to stay protected. One of the easiest ways to achieve this is to encourage your patients to get their flu shot. The flu shot is a covered benefit through Texas Medicaid, which means it’s available at no cost to them. Getting vaccinated helps protect them, their family, and the community from getting sick. It is simple, fast, and—again—available at no cost to our members. If they have any questions about Medicaid covering the flu shot, we can help. They can call us at: ■STAR Medicaid and CHIP: 915-532-3778 or toll-free: 1-877-532-3778. ■STAR+PLUS toll-free: 1-833-742-3127. If your offices are currently not providing flu shots, members can obtain one at their pharmacy. We would love the opportunity to help answer any Medicaid-related questions regarding the flu shot and where it can be obtained. Thank you for being the best part of El Paso Health.
RkJQdWJsaXNoZXIy OTI0MzU=