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4.1.1 Eligibility Verification
To verify client Medicaid eligibility, use the following options:
• Verify the client's Medicaid eligibility using form H1027 or H3087.
Refer to: "Medicaid Identification, Verification" .
•Verify electronically through TMHP EDI. Providers may inquire about a client's eligibility by electronically submitting the following information for each client:
•Medicaid or Children with Special Health Care Needs (CSHCN) Services Program identification number, or
•One of the following combinations: Social Security number and last name; Social Security number and date of birth; or last name, first name, and date of birth. Narrow the search by entering the client's county code or sex.
•Submit verifications in batches limited to 5,000 inquiries per transmission.
•Contact AIS at 1-800-925-9126, 1-512-335-5986, 1-512-335-6033, 1-512-335-6217, or 1-512-345-6476.
•Contact the TMHP Contact Center at 1-800-925-9126.
•Submit a hard-copy list of clients to TMHP. This service is only used for clients with eligibility that is difficult to verify. A charge of $15 per hour plus $0.20 per page payable to TMHP applies to this eligibility verification. The list includes names, gender, and dates of birth if the Social Security and Medicaid identification numbers are unavailable. TMHP can check the client's eligibility manually, verify eligibility, and provide the Medicaid identification numbers. Mail the lists to the following address:
Texas Medicaid & Healthcare Partnership
Contact Center
12357-A Riata Trace Parkway
Suite 100
Austin, TX 78727
PCCM primary care providers can also check the current month's panel report of clients assigned to their practice to determine whether the client's name and Medicaid number appear on the list. If the client's name and Medicaid number are shown, eligibility is guaranteed for that month only.
Refer to: "Monthly Client Panel Report" .
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