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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.6 Reimbursement

2.6
Providers must read and comply with Section 2: Texas Medicaid Fee‑for‑Service Reimbursement (Vol. 1, General Information).
Reimbursement for benefits that are administered by a Texas Medicaid MCO or dental plan is determined by the MCO or dental plan. Providers should contact the MCO or dental plan for additional information.
Note:
The MCOs and dental plans are not limited to following the Texas Medicaid fee schedules. There may be some differences in reimbursement based on decisions made by the individual health and dental plans.
Texas Medicaid reimburses carve-out services according to the appropriate reimbursement methodology defined in the applicable Texas Medicaid Provider Procedures Manual handbook and the applicable Texas Medicaid fee schedules, which are available on the TMHP website at www.tmhp.com.

Texas Medicaid & Healthcare Partnership
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