TMPPM 2008 >43.1.5 Eligibility for a Medical Check Up

43.1.5 Eligibility for a Medical Check Up

Through outreach, THSteps staff (the Department of State Health Services [DSHS], HHSC, or contractors) encourage clients to use THSteps preventive medical check up services when they first become eligible for Medicaid and each time thereafter when they are periodically due or overdue for their next medical check up.

Providers are encouraged to perform check ups on any client they identify as eligible for medical check ups. They also are encouraged to notify clients when they are due for the next check up according to the THSteps periodicity schedule.

The client is periodically eligible for medical check up services based on the THSteps Periodicity Schedule. A THSteps statement under the client's name on the regular client Medicaid Identification (Form H3087) and the State of Texas Access Reform (STAR) Identification (Form H3087 STAR) indicates the THSteps services for which the client is currently eligible. A check mark on the identification form indicates eligibility for the particular service, such as eye exam, eye glasses, hearing aid, dental, prescriptions, and medical services. A blank space denotes that the client is not eligible for the particular service based on available data.

Check ups provided when a THSteps statement does not indicate a medical check up is due must be billed as an exception to the periodicity schedule.

Refer to: "Exceptions to Periodicity" for further details about billing for a check up performed as an exception to periodicity.

Although the Medicaid Eligibility Verification Letter (Form H1027) identifies eligible clients when the client Form H3087 is lost or has not yet been issued, Form H1027 does not indicate periodic eligibility for medical check up services. Providers can call the TMHP Contact Center at 1-800-925-9126 or check the TMHP website at www.tmhp.com to verify a client's eligibility for medical check up services.