TMPPM 2011 > Volume 1, General Information > Welcome: 2011 Texas Medicaid Provider Procedures Manual

Welcome: 2011 Texas Medicaid Provider Procedures Manual

This manual is a comprehensive guide for Texas Medicaid providers. It contains information about Texas Medicaid benefits, policies, and procedures. It also includes information about Texas Health Steps (THSteps), the Children's Services Program and managed care programs, including Primary Care Case Management (PCCM).

Texas Medicaid policy published in this manual was implemented on or before January 1, 2011. Policy updates effective after January 2, 2011, are published bimonthly in the Texas Medicaid Bulletin.

All Texas Medicaid policy updates that are published bimonthly in the Texas Medicaid Bulletin supplement this manual and update the policy it contains.

This manual and copies of the Texas Medicaid Bulletin are available on the TMHP website at www.tmhp.com.

The 2011 Texas Medicaid Provider Procedures Manual (TMPPM) is divided into two volumes as follows:

Volume I: General Information

Volume 1 applies to all health-care providers who are enrolled in Texas Medicaid and provide services to Texas Medicaid clients. The sections in Volume 1 include general information for enrolling in the program, receiving appropriate reimbursement, and claim submissions and appeals for services rendered.

•Contents

•Introduction

•TMHP Telephone and Address Guide

•Section 1. Provider Enrollment and Responsibilities

•Section 2. Texas Medicaid Reimbursement

•Section 3. TMHP Electronic Data Interchange (EDI)

•Section 4. Client Eligibility

•Section 5. Prior Authorization

•Section 6. Claims Filing

•Section 7. Appeals

•Section 8. Managed Care

•Appendix A: State and Federal Offices Communications Guide

•Appendix B: Vendor Drug Program

•Appendix C: HIV/AIDS

•Appendix D: Medical Transportation

•Appendix E: Acronym Dictionary

•Index (for Volume 1 and all handbooks)

Volume 2: Provider Handbooks

Volume 2 includes 11 handbooks. Each handbook covers Medicaid policies, procedures, and claims filing requirements for specific products or services. Volume 2 includes the following handbooks:

•Ambulance Services Handbook

•Behavioral Health, Rehabilitation, and Case Management Services Handbook

•Children's Services Handbook

•Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

•Gynecological and Reproductive Health, Obstetrics, and Family Planning Services Handbook

•Hospital Services Handbook

•Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

•Nursing and Therapy Services Handbook

•Outpatient Services Handbook

•Radiology and Laboratory Services Handbook

•Vision and Hearing Services Handbook