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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.4 PCP/Main Dentist Guidelines for Medicaid Managed Care Clients : 2.4.2 PCP Requirements for THSteps Medical Services

2.4.2
THSteps providers must be enrolled with Medicaid to be reimbursed for services provided to clients. THSteps medical services are self-referred. Medicaid MCOs determine how their clients will access THSteps services. The MCO may require the client to go to an in-network THSteps provider or may allow the client to go to any Medicaid THSteps provider, whether or not they are in the MCO’s network. Providers that render THSteps services must work in collaboration with the client’s PCP to ensure continuity of care.
THSteps providers are required to bill claims as an exception to periodicity when the clients visit is outside of the periodicity schedule because of extenuating circumstances.
Refer to:
Section 5, “THSteps Medical”, subsection 5.3.7, “Exception-to-Periodicity Checkups”, and subsection 4.2.10.1, “Exceptions to Periodicity” in the Children’s Services Handbook (Vol. 2, Provider Handbooks) for more information about billing an exception-to-periodicity checkup.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.