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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 9 * Carve-Out Services : 9.1 Family Planning Carve-Out Services

9.1
Some family planning services are carved-out services for Texas Medicaid clients whose managed care benefits are administered through Seton Health Plan. These carved out services may be considered for payment by Texas Medicaid through TMHP if the service has been denied by the health plan as a family planning service.
All Seton Medicaid providers should submit family planning claims using the CMS-1500 paper claim form, or electronic equivalent, to the client’s managed care health plan in order to receive the health plan’s denial.
Important:

Texas Medicaid & Healthcare Partnership
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