Provider Lines
General Inquiries Line: 1-800-925-9126
This is a provider line responsible for assisting with issues not addressed by other available provider lines. The Contact Center Representative provides general information concerning the Texas Medicaid Program. Responsibilities include policy education, claims filing assistance, financial inquiries, eligibility inquiry, Title XIX Family Planning, and provider education.
Ambulance: 1-800-925-9126, Option 3
This Contact Center queue handles questions regarding claims, non-emergency ambulance prior authorizations, emergency transports, and informs provider of billing information concerning the Ambulance Program.
Family Planning: 1-800-925-9126, Option 4
This line assists providers with questions specific to Titles V, X, and XX Family Planning programs. This includes billing and policy questions which concern claims, prior authorizations, and claims research.
Provider Enrollment: 1-800-925-9126, Option 2
The Provider Enrollment queue is designed to assist providers with applications to enroll and update new and existing provider accounts, and questions concerning enrollment policy. Some of the responsibilities include: maintenance of provider accounts, advising providers on how to complete a Texas Medicaid program application, and answering questions regarding policies which impact enrollment.
Children with Special Health Care Needs: 1-800-568-2413
This is a general inquiry line concerning the Children with Special Health Care Needs program. The Contact Center Representatives on this line answer questions and resolve issues for all matters concerning this program. Responsibilities include: claim research, prior authorization information, policy, and billing information.
Provider Helpline: 1-888-834-7226
PCCM Provider Helpline assists providers specifically with PCCM benefit questions, primary care provider verification, complaints, and facilitating access to care.
Comprehensive Care Program (CCP)/ Home Health Line: 1-800-846-7470
Durable Medical Equipment (DME), Home Health, and CCP providers use this line for authorization related inquiry. Responsibilities entail prior authorization information, researching Title XIX forms, and benefit limitation questions.
Third Party Resources: 1-800-846-7307
This queue is for the providers to update other insurance information concerning a client's Medicaid account. The Contact Center Representatives' responsibilities include: other insurance verification, and other insurance updates.
Telephone Appeals: 1-800-745-4452
This line is available for providers to call and request claims to be appealed. The provider must have the most recent 24 digit claim number, and is limited to specific claim situations. Telephone appeals must follow the guidelines in the Texas Medicaid Provider Procedures Manual, Section 5.1.2.4.
Texas Health Steps Medical: 1-800-757-5691
This line is set up for questions concerning the Texas Health Steps Medical plan, specific to the program administration for children under the age of 21. Responsibilities include: Texas Health Steps Medical program information, billing information, appeals and benefit limitations concerning the periodicity schedule.
EDI Helpdesk: 1-888-863-3638
The EDI Help Desk assists providers and vendors with
TexMedConnect (TMC) access. The Help desk can reset TMC passwords and troubleshoot other TMC and EDI issues such as: internet requirements, EDI enrollment, transmission verification, TMC issues, file rejection, software requests, file resets, technical problems within the TMHP website, and ER&S download issues.
Texas Health Steps Dental:1-800-568-2460
This queue acts as a customer service and appeal line for all providers specific to Dental claims and policy issues. Responsibilities include: general inquiry, benefit limitations, and Dental claim appeals. |