Texas Star Kids & Becoming an In-Network Provider                      
Report contributed by Kate Harrison 

Music Therapists have an opportunity to become an “in-network” provider under a managed care plan for reimbursement of music therapy services. 

It is vital to the success of this program that we have a large number of MT-BCs sign up to become “in-network” providers.  The potential to expand coverage to other programs through this and other third-party payers, both within TX and in other states, depends upon the successful response to and use of this new program. 

Texas Star Kids is a new Medicaid managed care program through United Healthcare that will provide benefits to children and adults 20 and younger who have disabilities.  Families will have to contact United Healthcare to see if they are eligible to receive this benefit and if this program fits their needs before enrolling.  This program will go live 11/01/2016.  This is the first time a managed care organization is offering a music therapy benefit to its members.  

 In order for you to be considered a provider, you would need to be in the MTM network (a company that has contracted with UHC to get this program going) – that just means you have met certain standards that the health plan and MTM have agreed upon. 

The process then is this:  The health plan is responsible for authorizing the music therapy service.  The plan contacts MTM stating they have a member who is in need of the service.  MTM contacts a provider in the network based on location, specialty and types of clients served and offers that provider the referral.  

You as the provider can either accept or reject the referral.  If you accept the referral, you will contact the member and set up the appointments.  Once the appointment is complete, you will send MTM an invoice for the session along with a treatment note for that session.  You will get paid by MTM; there are no specific billing codes or forms needed to submit your invoice, MTM just needs a copy of the date of service, member’s name and amount due.  You can submit the invoice however you normally do your billing.  

This is an incredible opportunity to improve access to music therapy services through direct third-party reimbursement. We are hopeful you will seriously consider becoming an “in-network” provider if this area of practice falls within your clinical expertise.  This new program covers both inpatient and outpatient treatment.

To become a participating provider for this new program please contact: 

Cheryl Looney 
HCBS, RN MSN 
Manager, Care Coordination, MTM, Inc.
Phone: 636.695.5617
E-mail: clooney@mtm-inc.net 

Editor's Note: Find out more information about the Texas STAR Kids program from Texas Human Health & Services.  Read about the patient's perspective on the need for clinicians to sign up as In-Network providers for Texas Star Kids in this article from DFW area news outlet WFAA, where patients describe their concerns about an adequate number of quality professionals signing up to provide care.