TMPPM 2011 > Children's Services Handbook > THSteps Medical > Enrollment > THSteps Medical Provider Enrollment > Medicaid Managed Care Enrollment

5.2.1.2 Medicaid Managed Care Enrollment

The Medicaid Managed Care program consists of two types of health-care delivery systems: Primary Care Case Management (PCCM) and health maintenance organizations (HMOs).

Clients enrolled in PCCM receive both THSteps medical and dental checkup services. PCCM clients may call 1-877-847-8377 to seek assistance in finding a THSteps provider. THSteps medical providers do not have to enroll with PCCM to be reimbursed for THSteps medical checkup services provided to PCCM clients, although coordination with the client's primary care provider is required.

Medicaid HMOs in the STAR and STAR+PLUS programs provide medical checkup services to their members. The Medicaid HMO in the STAR Health program provides both medical and dental checkups to its members. Medicaid HMO clients should check with their HMO to see whether they must select a provider in the network for THSteps checkups prior to receiving the services. Medicaid HMO providers must meet contractual obligations established by their respective HMOs with regards to providing medical checkups to THSteps clients. Medicaid HMO providers are reimbursed for THSteps medical checkup services through their HMO.

THSteps providers should encourage clients to see their primary care provider as their medical home. If the client's primary care provider is not a THSteps medical provider, the checkup provider must send the primary care provider the records from all THSteps medical checkups performed for the client.

All primary care providers are encouraged to enroll as THSteps medical providers. This allows the client to receive both acute care services and preventive THSteps services from the same provider.

Refer to: Section 8: Managed Care (Vol. 1, General Information).