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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.2 Client Lock-in Program : Hospital Services
An inpatient hospital claim for a lock-in Medicaid fee-for-service client is considered for reimbursement if the client meets Medicaid eligibility and admission criteria. Hospital admitting personnel are asked to check the name of the designated provider for the client that is noted on the Your Texas Benefits Card website at and inform the admitting physician of the designated provider’s name if the two are different.
Provider claims for nonemergency inpatient services for lock-in Texas Medicaid fee-for-service clients are considered for payment only when the designated provider identifier appears on the claim form as the billing, performing, or referring physician.
Providers can get information about claim reimbursement for lock-in clients by calling the TMHP Contact Center at 1‑800‑925‑9126.

Texas Medicaid & Healthcare Partnership
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