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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook

Women’s Health Services Handbook
Table of Contents
1 * General Information 4
2 Healthy Texas Women (HTW) Program Overview 4
2.1 Guidelines for HTW Providers 5
2.1.1 Referrals 6
2.1.2 Referrals for Clients Diagnosed with Breast or Cervical Cancer 6
2.1.3 Abortions 6
2.2 HTW Provider Enrollment 7
2.3 * Services, Benefits, Limitations, and Prior Authorization 7
2.3.1 Family Planning History Check 9
2.3.2 Family Planning Annual Exams 9
2.3.2.1 FQHC Reimbursement for Family Planning Annual Exams 10
2.3.3 Other Family Planning Office or Outpatient Visits 10
2.3.3.1 * FQHC Reimbursement for Other Family Planning Office or Outpatient Visits 10
2.3.4 * Laboratory Procedures 10
2.3.5 Contraceptive Devices 11
2.3.6 Drugs and Supplies 11
2.3.6.1 Prescriptions and Dispensing Medication 11
2.3.6.1.1 Long-Acting Reversible Contraception Products 12
2.3.7 Sterilization and Sterilization-Related Procedures 12
2.3.7.1 Sterilization Consent 12
2.3.8 Treatment for Sexually Transmitted Infections (STIs) 12
2.3.9 Immunizations and Vaccinations 12
2.3.10 Prior Authorization 13
2.4 Documentation Requirements 13
2.5 HTW Claims Filing and Reimbursement 13
2.5.1 Claims Information 13
2.5.1.1 HTW and Third Party Liability 13
2.5.2 Reimbursement 13
2.5.3 National Drug Code 13
2.5.4 NCCI and MUE Guidelines 13
3 Health and Human Services Commission (HHSC) Family Planning Program Services 14
3.1 Provider Enrollment for HHSC Family Planning Program Contractors 14
3.2 Services, Benefits, Limitations, and Prior Authorization 14
3.2.1 Family Planning Annual Exams 15
3.2.1.1 FQHC Reimbursement for Family Planning Annual Exams 15
3.2.2 Family Planning Office or Outpatient Visits 16
3.2.2.1 FQHC Reimbursement for Family Planning Office or Outpatient Visits 16
3.2.3 Laboratory Procedures 17
3.2.3.1 HHSC Family Planning Program 17
3.2.4 Immunization Administration 17
3.2.4.1 Human Papilloma Virus (HPV) Vaccine 17
3.2.5 Radiology 18
3.2.6 Contraceptive Devices and Related Procedures 18
3.2.6.1 External Contraceptives 18
3.2.6.2 IUD 18
3.2.6.2.1 Insertion of an IUD 18
3.2.6.2.2 Removal of the IUD 18
3.2.6.3 Contraceptive Capsules 19
3.2.6.4 Medroxyprogesterone Acetate/Estradiol Cypionate 19
3.2.7 Drugs and Supplies 19
3.2.7.1 Prescriptions and Dispensing Medication 19
3.2.7.2 Oral Medication Reimbursement 20
3.2.8 Family Planning Education 20
3.2.8.1 Medical Nutrition Therapy 20
3.2.8.2 Instruction in Natural Family Planning Methods 20
3.2.9 Sterilization and Sterilization-Related Procedures 20
3.2.9.1 Sterilization Consent 20
3.2.9.2 Incomplete Sterilizations 20
3.2.9.3 Tubal Ligation and Hysteroscopic Occlusion 20
3.2.9.4 Vasectomy 20
3.2.10 Prior Authorization 21
3.3 Documentation Requirements 21
3.4 Claims Filing and Reimbursement 21
3.4.1 Claims Information 21
3.4.1.1 Filing Deadlines 21
3.4.1.2 Third Party Liability 21
3.4.2 Reimbursement 21
3.4.2.1 Funds Gone 21
3.4.3 NCCI and MUE Guidelines 22
3.4.4 National Drug Code 22
4 Claims Resources 22
5 Contact TMHP 22
6 Forms 22
 

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