Table of Contents Previous Next

December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 1 General Information

1 General Information
The information in this handbook is intended for Texas chiropractors, nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM), certified registered nurse anesthetists (CRNA), podiatrists, geneticists, maternity service clinics, physicians, and physician assistants. The handbook provides information about Texas Medicaid’s benefits, policies, and procedures.
All providers are required to read and comply with Section 1: Provider Enrollment and Responsibilities. In addition to required compliance with all requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide healthcare services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1659. Accordingly, in addition to being subject to sanctions for failure to comply with the requirements that are specific to Texas Medicaid, providers may also be subject to Texas Medicaid sanctions for failure, at all times, to deliver healthcare items and services to Medicaid clients in full accordance with all applicable licensure and certification requirements including, without limitation, those related to documentation and record maintenance.
Refer to:
Subsection 2.2, “Provider Enrollment and Responsibilities,” in the Medicaid Managed Care Handbook (Vol. 2, Provider handbooks).
Section 5, “THSteps Medical” in the Children’s Services Handbook (Vol. 2, Provider Handbooks).
For information on Advanced Practice Registered Nurses (APRNs), refer to the following subsections in this handbook:
Section 3, “Certified Nurse Midwife (CNM)”
Section 4, “Certified Registered Nurse Anesthetist (CRNA)” Subsection 4.1, “Enrollment”
Section 5, “Geneticists” Subsection 5.2, “Services, Benefits, Limitations, and Prior Authorization”
Section 8, “Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS)” Subsection 8.1, “Enrollment”
Section 9, “Physician” Subsection 9.2, “Services, Benefits, Limitations, and Prior Authorization”

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