TMPPM 2008 > Texas Medicaid Services > Case Management for Children and Pregnant Women (CPW) > Benefits and Limitations

12.3 Benefits and Limitations

CPW services are limited to one contact per day per client. Additional provider contacts on the same day are denied as part of another service rendered on the same day.

Providers must adhere to CPW case management program rules, policies, and procedures.

All services must be prior authorized. One comprehensive visit is approved for all eligible clients. Follow-up visits are authorized based on contributing factors. Additional visits can be requested and may be authorized based on a continuing need for services. A prior authorization number is required on all claims for CPW services.

Note: Prior authorization is a condition of reimbursement, not a guarantee of payment.

Approved case management providers may request prior authorization from DSHS by fax (1-512-458-7574) or on the website at www.dshs.state.tx.us/caseman/subpaweb.shtm.

Note: CPW providers are not required to file claims with other health insurance before filing with Medicaid.

Reminder: Billable services are defined in program rule 25 TAC §27.5.

CPW services are not billable when a client is an inpatient at a hospital or other treatment facility.

Reimbursement for services rendered by providers not approved by the DSHS Health Screening and Case Management Unit will be denied.

Providers must document all services in accordance with program rule, program policy, and Medicaid policy.