TMPPM 2008 > Texas Medicaid Services > Hospital (Medical/Surgical Acute Care Facility) > General Information

25.1 General Information

25.1.1 Introduction

The information in this section is intended for traditional Texas Medicaid Program hospital (medical/surgical acute care facility) providers. The section provides information about the Texas Medicaid Program's benefits, policies, and procedures applicable to acute care hospitals in the inpatient and outpatient setting.

Note: Although Medicaid Managed Care providers must provide all medically necessary Medicaid-covered services to eligible clients, these providers must refer to the respective health plan documentation for specific information about hospital services, claims filing, etc.

Refer to: "PCCM" .

While this section contains some claims filing and appeals information, hospitals should continue to refer to "Claims Filing" and "Appeals" for more comprehensive information about these subjects. An effort has been made to provide comprehensive information about hospital services in this section; however, hospital providers are encouraged to review other sections of the manual for specific requirements for special programs such as the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) and other pertinent material impacting health-care providers rendering care in the hospital setting.

Refer to: "Procedure Codes Requiring Prior Authorization" for a list of procedures requiring prior authorization. Also, review the index and individual sections for other information about prior authorization requirements.