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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.2 Eligibility Verification

To verify a client’s Texas Medicaid eligibility, use the following options:
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. Providers can narrow the search by entering the client’s county code or sex.
Contact the TMHP Contact Center or AIS at 1‑800‑925‑9126 or 1-512-335‑5986.
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 ID numbers are unavailable. TMHP can check the client’s eligibility manually, verify eligibility, and provide the Medicaid ID numbers. Mail the lists to the following address:
Texas Medicaid & Healthcare Partnership Contact Center
12357‑A Riata Trace Parkway
Suite 100
Austin, TX 78727
Providers can obtain client eligibility information for a client who is enrolled in a Medicaid managed care organization (MCO) from the MCO’s web page. Providers can also check the MCO’s web page for submission of electronic claims, prior authorization requests, claim appeals and reconsiderations, exchange of clinical data, and other documentation necessary for prior authorization and claim processing.

Texas Medicaid & Healthcare Partnership
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