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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 9 * Carve-Out Services

9
Some services are “carved out” of one or more of the managed care programs. Carved out services are those that are rendered to Medicaid managed care clients, but are processed for payment consideration by TMHP and not an MCO or dental plan.
The following table shows the services that are partially or completely carved out of the MCO and dental plan managed care program as well as services that are no longer carved out as of March 1, 2012:
 
Family planning services for Seton managed care health plan
DARS Blind Children’s Vocational Discovery and Development Program
 
Orthodontia for most clients who are 20 years of age and younger
Orthodontia for clients who turned 21 years of age before March 1, 2012, and whose services were authorized by TMHP before March 1, 2012
Note:
Authorization requests for services that are carved out of the managed care program must be submitted to TMHP according to the fee-for-service guidelines that are established for the same service.
Claims filing for services that are carved out of the managed care program must be submitted to TMHP according to the fee-for-service guidelines that are established for the same service.
Providers should refer to the appropriate Texas Medicaid Provider Procedures Manual handbook for the applicable authorization request and claims filing guidelines.

Texas Medicaid & Healthcare Partnership
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