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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 8 Children’s Medicaid Dental Services : 8.6 Authorizations for Children’s Medicaid Managed Care Dental Services (Non-orthodontia Services)

8.6
Authorization requests for services administered by the client’s dental plan must be submitted to the client’s dental plan according to the guidelines specific to the plan under which the client is covered.
If a member is new to a dental plan and has an open authorization for covered dental services from TMHP or another HHSC-contracted Medicaid managed care dental plan, the dental plan must accept that authorization and cannot require additional authorization or review.
TMHP authorizes and processes dental and emergent orthodontic services for clients who are 20 years of age and younger but have not yet enrolled in a dental plan.
TMHP also authorizes services for the following clients:
Dental and orthodontia services for all Medicaid clients, regardless of age, who reside in Medicaid-paid facilities such as nursing homes, state-supported living centers, or ICF-IIDs
Exception:

Texas Medicaid & Healthcare Partnership
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