Welcome: 2012 Texas Medicaid Provider Procedures Manual

This manual is a comprehensive guide for Texas Medicaid providers. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including medical, dental, and children's services benefits.

Refer to:

Medicaid Managed Care Handbook (Vol. 2, Provider Handbooks) for information about the Medicaid Managed Care, which is administered by Texas Health and Human Services Commission (HHSC)-contracted managed care organizations (MCOs), dental managed care organizations, and behavioral health organizations (BHOs) across the state.

Texas Medicaid policy published in this manual was implemented on or before January 1, 2012. Policy updates effective after January 2, 2012, 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 2012 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 fee-for-service 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. An index for Volume 1 and all handbooks appears at the end of Volume 1.

Volume 2: Provider Handbooks

Volume 2 includes 13 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

•	Clinics and Other Outpatient Facility Services Handbook

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

•	Gynecological and Reproductive Health and Family Planning Services Handbook

•	Inpatient and Outpatient Hospital Services Handbook

•	Medicaid Managed Care Handbook

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

•	Medical Transportation Program Handbook

•	Nursing and Therapy Services Handbook

•	Radiology and Laboratory Services Handbook

•	Vision and Hearing Services Handbook