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If you need any of the following information in alternative formats or languages please contact us at 1-866-566-8989. Administrative Error Impacting Access to Care STARLink confirmed with DHS that an error was made and that the case should not have been terminated. STARLink advised the client to contact the provider's office and reschedule the appointment as it was impossible to get the case corrected in time for the appointment. STARLink followed up for 3 days until the case was reopened and the client was able to obtain a temporary Medicaid form and get in to see the doctor. A twenty-five-year-old pregnant woman called STARLink after running into problems accessing prenatal care. She had moved 3 months ago, at which time her Medicaid case information was updated correctly but an error on her case several months later re-enrolled all of the members of her family back into a managed care plan when she no longer lived in a managed care area. The mother was due to deliver within a week and both of her children needed to see a doctor for sick visits and immunizations. Her local DHS office would not issue temporary Medicaid forms due to the managed care information. STARLink worked with the state to correct the enrollment information. Within 1 week the family was "removed" from the managed care program and able to access care. STARLink also communicated with the providers regarding the problems and its resolution. As a result the provider continued to seeing the patient and were able to successfully submit claims once the error was corrected. 
Systems Interface Preventing Access to Care STARLink reassured the client that her problem would be resolved and encouraged her to focus on her health. The client was extremely anxious about the situation and her stress was putting her pregnancy at risk. STARLink began working with DHS to find out what the problem was and initiate a solution. Following 1 month of weekly follow up and no resolution or explanation in sight STARLink elevated the problem to HHSC and requested intervention. By this time the client was trying to register at the hospital where she planned on delivering her baby but she was unable to do so because the hospital couldn't verify her Medicaid coverage. After more than 20 follow ups over a month and a half the client's eligibility information was successfully updated, the providers claims were processed and the client was able to continue care with her ObGyn and deliver at the hospital of her choice. The guardian of an adult with a disability called STARLink because she had not received her son's Medicaid ID form. In reviewing the case STARLink discovered that in addition to an error in the address, her son had been erroneously disenrolled from the STAR program due to a Medicare exclusion. The problem was, her son did not have Medicare coverage. STARLink had assisted the mother with the very same issue the previous year. Periodically the system activates the Medicare segment which throws the person off the STAR program. STARLink contacted the state and requested that they remove the Medicare segment. As a result the client was back on the STAR program the following month. In the meantime STARLink assisted the guardian in getting the address corrected through the Social Security Administration and referred her to local resources for assistance with his prescription needs.
Access to CCP Services STARLink contacted the supply company and assisted them in getting all the needed information and paperwork from the PCPs office to submit to the plan for approval. The mother received the feeder the following week.
Access to Out-of-Network Services STARLink contacted the health plan, explained the situation and clarified the health plan's responsibility to provide service to its members. Authorization for the evaluation was provided the same day. The mother of a 15-year-old boy called STARLink for help in accessing behavioral health services in the Travis area. Her son was recently seen by a psychologist but the provider was unable to get paid for the service and told the mother they would not be able to continue seeing the child. STARLink discovered that even though the family had lived in Austin for the past 12 years the child's Medicaid case still had a Dallas county code on it which erroneously forced the child to be enrolled in the Dallas area NorthSTAR program. STARLink worked with DHS to get the error corrected and then requested that the NorthSTAR program disenroll the child retroactively so the provider could get paid for services delivered and the child could continue receiving care. The mother of a 6-year-old child who lived in El Paso called STARLink needing help getting her son in to see an out-of-network neurologist in Houston. The child's local neurologist recommended further evaluation and possible surgery with the neurologist in Houston. The mother had previously requested that her son be disenrolled from the managed care program but due to an error her son was going to remain on the program for another month. The child had an appointment scheduled in 10 days and the neurologist refused to accept out-of-network payment unless it was 80% of the provider's charges (well over the Medicaid rate). STARLink immediately requested that the child be disenrolled from the managed care program retroactively. The state and STARLink worked together with the family and providers and as a result the child was able to go to his previously scheduled appointment and receive the necessary consultation without delay.
Access to Prescriptions STARLink was also unable to reach anyone at the PCP's office. As a result STARLink contacted the Regional Pharmacist who authorized a refill that same day. STARLink also advised the patient of her right to change PCPs and assisted her in contacting her health plan, filing a complaint and changing PCPs immediately.
Delay of Referral
STARLink contacted the PCPs office who confirmed that a referral had been sent and provided STARLink with the date. STARLink then contacted the specialist's office, assured them that the referral had been sent and insisted that they look for it. After searching the office they found the referral in a stack of paperwork and STARLink assisted the mother in rescheduling the appointment for the very next day. The mother of a 16-year-old boy called STARLink when she was unable to get her PCP to provide the necessary referral for her son's cataract removal surgery which was already scheduled for the following week. The office manager at the PCP's office stated that he was not going to assist the mother in completing any referral paperwork. STARLink contacted the child's health plan, explained the problem with the office manager and requested the plan assist the mother and the specialist in obtaining authorization for the surgery. As a result authorization was approved and the child received the surgery as scheduled.
Appointment Availability
Since the client expressed a history of not being able to get timely appointments with his PCP STARLink assisted him in contacting his health plan to change his PCP. STARLink helped the client find a suitable PCP, made sure the PCP change was entered retroactively and helped him schedule an appointment in less than a week. The mother of a 4-year-old child called STARLink from her DHS office complaining that her son is coming down with pneumonia and his PCP can not see him within the next day. STARLink advised the mother that she should contact the health plan and get assistance with her urgent care request. In reviewing the case STARLink also noticed that DHS had updated her address on her food stamp case but not her son's Medicaid case. Since the mother was at the office to pick up a temporary form she requested that they correct the address too. The mother of a two-year-old child with a seizure disorder called STARLink to get help in changing her child's PCP. Every time her child was sick or had an episode of seizures the PCP would be unable or unwilling to schedule an appointment and repeatedly referred the mother to the Emergency Room. STARLink assisted the mother in contacting her child's health plan to file a complaint and to request an immediate PCP change to a provider who was more familiar with treating children with seizure disorders.
Telephone Access STARLink called the change center and after 15 attempts was able to get through and transferred the mother to the unit to update her address.
County Code Errors STARLink contacted DHS the same day to request a correction to the county code. It took 22 days of daily follow up and repeated requests to get the county codes corrected on all of the cases.
Children's Recertification STARLink contacted the local DHS office who informed the mother that she would need to send in another application for her son. The mother had listed ALL of her children on the renewal paperwork and signed off that there were no changes. After enlisting the assistance of the Regional DHS office it still took 22 days for the child's Medicaid to be renewed. Neither the local case worker nor the regional contact was able to be reached for follow up. The mother of a 1-year-old child called STARLink because she had to cancel her daughter's upcoming surgery since the child's Medicaid was not renewed. She had mailed in the renewal paperwork as required but the case had not been recertified. STARLink assisted the mother in contacting the Regional office and the child's Medicaid was recertified by the next week. |
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