STAR+PLUS: Transition process for El Paso Health members Service plans Members’ existing service plans (SP) or individual service plans (ISP) will stay in place until El Paso Health service coordinators contact the member or their authorized representative to schedule an assessment. This assessment will determine if changes to the ISP are needed. Authorizations: In-network Providers For members who transition to El Paso Health’s STAR+PLUS plan, we will continue authorizations of current services in the same amount, duration, and scope for the shortest period of one of the following: 1. Up to 6 months after the member transfers to El Paso Health. 2. Until the El Paso Health service coordinators complete all required assessments, develop a new SP or ISP, and issue new authorizations. Authorizations: Out-ofnetwork (OON) Providers El Paso Health will continue authorizations of current services in the same amount, duration, and scope for the shortest period of one of the following: 1. Members can continue to see their current Providers, even if they are outside the health plan’s network. 2. If a member wants to stay with their current Provider who is OON, the managed care organization may seek to obtain a single-case agreement, OON authorization, or similar arrangement with the Provider to ensure continuity of care. 3. El Paso Health will continue to pay a member’s existing OON Provider for covered services for up to: ■ 90 days for acute care. ■ 6 months for long-term services and supports. ■ 9 months for a member who has been diagnosed with and is receiving treatment for a terminal illness. For OON Providers, please contact El Paso Health’s Contracting and Credentialing Department at 1-833-742-3127 or email contracting_dept@elpasohealth.com. Get ready for 2025 coding updates Claim denials can be a big problem. If not addressed quickly, frequent claim denials hurt your practice’s revenue and could possibly impact your ability to provide patient care. Even small coding errors can cause a claim to be denied. To prevent unnecessary claim denials, be sure to update your practice management software with the 2025 coding changes. ■ICD-10-CM/PCS codes for fiscal year 2025 will be effective on Oct. 1, 2024. ■Updates for CPT and HCPCS codes will be effective on Jan. 1, 2025. Review the new additions, deletions, and revisions to avoid claim denials due to incorrect diagnosis or procedure codes. stay informed 3
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