Texas
Medicaid/CHIP and VDP-Enrolled Pharmacies
A discussion of options for pharmacies enrolled in the Texas Medicaid programs, including
enrollment options, durable medical equipment (DME) and Comprehensive Care
Program (CCP) claim processes, and other questions a Vendor Drug Program (VDP)-enrolled pharmacy
may have about TMHP. (Posted 8/26/2011)
CSHCN
Administrative Review Process
A conversation about the administrative review process with the Children with
Special Health Care Needs (CSHCN) Services Program. The administrative review
process is discussed along with some common pitfalls that result in claim
denials and appeals. (Posted 7/8/11)
Policy Changes
for OB Ultrasounds
Dr. Rachel
Pryzbyla, Medical Director for Policy Development at TMHP, describes policy
changes requiring prior authorization for OB Ultrasounds under Texas Medicaid.
(Originally posted 8/18/2010)
PA for PET and Cardiac Nuclear Imaging
Effective for dates of service on or after February 1, 2010, MedSolutions will administer the prior authorizations for all radiology procedures including computed tomography (CT), magnetic resonance (MR), positron emission tomography (PET) scan, and cardiac nuclear imaging services. This edition of Radio TMHP features answers to questions that providers may have regarding the upcoming changes. (Originally posted 12/17/09)
Case Management for Children and Pregnant Woman
This edition of Radio TMHP features a conversation with Cossy Hough, Case
Management Branch Manager from DSHS, about the Case Management for Children and
Pregnant Woman (CPW) program. Cossy offers some background on the benefit, its
eligibility requirements, and the requirements for enrolling as a provider. She
also offers examples of what services can be provided to clients under this
benefit. (Originally posted 6/25/09)
CSHCN Services Program
This edition features a conversation about Children with Special Health Care
Needs (CSHCN) Services Program clients at federally qualified health centers and
rural health clinics. It outlines the steps that providers at those clinics need
to take to enroll in the CSHCN Services Program in order to be reimbursed for
the care they give our clients. (Originally posted 1/25/09)