4.3.2.1 Limited Medicaid IdentificationClients with limited status receive a Form H3087 with the printed word "LIMITED." A limited client is defined as "a client who is limited to a designated primary care provider and/or primary care pharmacy." The designated provider names are printed on the form under the word "LIMITED." The limited Medicaid Identification identifies a client who has overutilized the services. Only one client is identified on a LIMITED Form H3087. For questions about pharmacy services for clients limited to a primary care pharmacy, contact the Limited Program Hotline at 1-800-436-6184, option 4. The Limited Program may also alert providers by means of a special message on the Form H3087, when the form was reportedly used by an unauthorized person or persons, or for an unauthorized purpose. In these cases, the provider is asked to verify the client's identity by requesting personal identification that carries a photograph, such as a driver's license. Payment for services to a limited Medicaid client, who is not in a managed care plan, is made to the designated provider only, unless services result from a designated provider referral or emergency. An automated review process determines if the claim includes the limited primary care provider's provider identifier as the billing, performing, or referring provider. When the limited primary care provider's provider identifier is not indicated on the claim, the claim is not paid. Exceptions to this rule include emergency care and services that are included in "Exceptions to Limited Status" . Appeals for denied claims are submitted to TMHP and must include the designated Medicaid provider identifier for reimbursement consideration. When limited traditional Medicaid clients attempt to obtain nonemergency services from someone other than their limited provider, the provider does one of the following:
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Verify the limited status with HHSC at 1-800-436-6184, option 4, TMHP at 1-800-925-9126, or online at 
