TMPPM 2008 > Provider Information > Managed Care > PCCM

   
 

7.5.3 Client Eligibility

HHSC has targeted the following client groups for PCCM enrollment:

Type
Program
Enrollment Code

1

Regular TANF

M

3

MAO RSDI Increases - No Medicare

M*

7

12 months Medicaid denied due to earnings

M

12

SSI Manually Certified - No Medicare

M*

13

SSI Recipient - No Medicare

M*

18

Disabled Adult Children denied SSI due to increase in SS benefits - No Medicare

M*

19

Transitional SSI - No Medicare

V

20

04 months Medicaid - TANF

M

29

12 months transitional Medicaid - limited TANF

M

22

Early Age Widows/Widowers - No Medicare

M*

37

12 months transitional Medicaid denied due to earned income; disregards ending

M

40

Pregnant women

M

43

Children under 1 year of age with income below 185% FPIL

M

44

Children 6-19 yrs. with income below 100% FPIL

M

45

Children up to 1 year of age born to Medicaid eligible mother

M

47

Medicaid for deprived children with step-grandparent income

M

48

Children 1-5 years of age with income below 133% FPIL

M

61

TANF State Program

M

M = Mandatory, V = Voluntary, M* = Mandatory adults ages 21 yrs. of age and older

To verify a client's eligibility and primary care provider, use one or more of the following eligibility resources:

Medicaid Identification Form (Form H3087).

Primary care provider change notification letter (see "Primary Care Provider Changes" ).

Monthly panel report.

Daily primary care provider change list.

TMHP website at www.tmhp.com.

TMHP EDI.

Automated Inquiry System (AIS) at 1-800-925-9126, option 1.

PCCM Provider Helpline at 1-888-834-7226.

TMHP Contact Center at 1-800-925-9126, option 5.

In some situations, an eligibility response may indicate that the provider should contact PCCM to verify the primary care provider information. For more information, please call the TMHP Contact Center at 1-800-925-9126, or the PCCM Provider Helpline at 1-888-834-7226.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
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