| Revised Texas Medicaid Fee Schedules Available July 5, 2009
Information posted July 3, 2009: Beginning July 5, 2009, the revised Texas Medicaid Fee Schedules will be available on this website. Providers can request a free paper copy of a fee schedule by calling the TMHP Contact Center at 1-800-925-9126. |
| Inmates of Public Correctional Institutions Ineligible for Coverage of Medicaid Services
Information posted July 3, 2009: Federal financial participation (FFP) is not available to reimburse providers for services provided to Texas Medicaid clients who are inmates of public correctional institutions or holding facilities (Code of Federal Regulations, Title 42, 435.1009). Click on the title to view the details. |
| Update to Third-Party Resources Type of Coverage Codes
Information posted July 3, 2009: Effective August 29, 2009, TMHP will update the TexMedConnect and Electronic Data Interchange (EDI) systems with a new type of coverage code for clients who have a Medicare Advantage Plan (MAP). The eligibility verification screen will display “M” on the Other Insurance Segments if the client is enrolled in a MAP in addition to Medicaid. Click on the title to view the details. |
| New AIS Eligibility Inquiry Responses Beginning August 31, 2009
Information posted July 3, 2009: Beginning August 31, 2009, the Automated Inquiry System (AIS) eligibility inquiry responses will provide more detail about a client’s type of Medicaid coverage. Click on the title to view the details. |
| TMHP to Enhance TexMedConnect
Information posted July 3, 2009: On August 29, 2009, TMHP will implement new features that will make it easier to navigate and enter data on TexMedConnect. Acute care providers will also be able to access more client eligibility information through the online system. Click on the title to view the details. |
| Revised Taxonomy Codes for Hearing Aid Providers
Information posted July 3, 2009: TMHP has revised the taxonomy codes available to otologists and otorhinolaryngologists (ENTs), hearing aid fitters and dispensers, and audiologists who are enrolled as hearing aid providers (i.e., the provider’s enrollment letter indicates “Hearing Aid”). Click on the title to view the details. |
| Implementation of TPN Services Benefit and Prior Authorization Changes Delayed
Information posted July 3, 2009: Changes to benefits and prior authorization requirements for total parenteral nutrition (TPN) services, which were announced with a July 1, 2009, effective date, have been delayed until August 15, 2009. Click on the title to view the details. |
| New Banner Messages Are Available
Information posted July 3, 2009: Banner messages containing important informational updates regarding the Medicaid, Managed Care, Family Planning, and CSHCN Services Programs appear on the providers' Remittance and Status (R&S) reports each week. Click on the title to view this week's banner messages. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information
Information posted July 1, 2009: The Children with Special Health Care Needs (CSHCN) Services Program has removed 158 clients from the program's waiting list. The effective date of this removal is July 1, 2009. These new clients received a gray CSHCN Services Program Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health-care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| August 2009 CSHCN Provider Bulletin No. 71
Information posted July 1, 2009: The August 2009 CSHCN Provider Bulletin No. 71 is now available. Click the title to view the bulletin.
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| New DME Procedure Code Benefit
Information posted June 26, 2009: Effective for dates of service on or after July 1, 2009, procedure code 9-K0739 will be a new benefit of both Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. The reimbursement rate for procedure code 9-K0739 will be $13.21, which will be payable for clients of all ages. Click on the title to view the details.
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| Incorrect PAF Form in CD Edition of the 2009 CSHCN Services Program Provider Manual
Information posted June 26, 2009: TMHP has identified an issue with the compact disc (CD) edition of the 2009 CSHCN Services Program Provider Manual. The CSHCN Services Program Physician/Dentist Assessment Form (PAF) published in the CD edition of the manual, was not the correct version of the form. The correct form, with a revision date of April 2008, is included in the print edition of the manual and in the file library of this website.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
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| Correction to Telephone Numbers for CSHCN Services Program Regions 9 and 10
Information posted June 26, 2009: This is a correction to a website article that was published on this website on June 19, 2009, titled “2009 CSHCN Manual Correction to Telephone Numbers for Regions 9 and 10.” Click on the title to view the details.
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| Correction and Clarification for CDTF Services
Information posted June 26, 2009: This is a correction and clarification to information that was published in the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin, No. 1, about chemical dependency treatment facility (CDTF) services. Click on the title to view the details. |
| TMHP Scheduled System Maintenance
Information updated June 25, 2009: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on Sunday, July 12, 2009, from 6:00 p.m. until Monday, July 13, 2009 at 3:00 a.m. During the system maintenance window, some applications will be unavailable for both Acute Care and Long Term Care systems. |
| Some Remittance & Status (R&S) Reports Not Available for Immediate Download
Information posted June 22, 2009: TMHP has identified an issue that affects some of this week’s Remittance & Status (R&S) Adobe portable document format (PDF) files, which are not available for immediate download. All R&S reports will be available for download from this website by 2 p.m. Monday, June 22, 2009. For more information, call the TMHP EDI Helpdesk at 1-888-863-3638. |
| EDI Batch Identification Numbers to Change Effective July 31, 2009
Information posted June 19, 2009: Effective July 31, 2009, the format for the 8-character batch identification number assigned to claims received through the TMHP Electronic Data Interface (EDI) Gateway will change. Click on the title to view the details. |
| Youth Empowerment Services Waiver
Information posted June 19, 2009: The Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS) received federal approval in February 2009 to implement a 1915(c) Medicaid Waiver. This program, called Youth Empowerment Services (YES), allows more flexibility in the funding of intensive community-based services and supports for children with serious emotional disturbances (SED) and their families. Click on the title to view the details. |
| TMHP Radio Now Featuring Children and Pregnant Women (CPW) Program Information
Information posted June 19, 2009: This month, TMHP Radio will feature a conversation with Cossy Hough, Case Management Branch Manager from the Department of State Health Services (DSHS), about the Case Management for Children and Pregnant Woman (CPW) program. Click on the title to view the details.
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| Women’s Health Program (WHP) Providers and Performance of Elective Abortions
Information posted June 19, 2009: As of September 1, 2005, Section 32.0248(h) of the Human Resources Code prohibits the Health and Human Services Commission (HHSC) from paying Women’s Health Program (WHP) funds to a provider that performs elective abortions. To enable HHSC to comply with this requirement, a WHP Provider Certification form will be mailed on June 22, 2009, to all billing providers that have delivered WHP services during the calendar years 2008 and 2009. Click on the title to view the details.
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| Update to Texas Medicaid Implements Molecular Laboratory Services Reimbursement Rates
Information posted June 19, 2009: This is an update to an article that was published on this website on May 29, 2009, titled “Texas Medicaid Implements Molecular Laboratory Services Reimbursement Rates.” Click on the title to view the complete, updated article.
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| Update to Online Fee Lookup Will Be Available to Texas Medicaid and CSHCN Services Program Providers
Information posted June 19, 20090: This is an update to an article that was published on the TMHP website on May 8, 2009, titled “Online Fee Lookup Will Be Available to Texas Medicaid and CSHCN Services Program Providers.” Click on title to view details.
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| TPN Prior Authorizations to Be Extended
Information posted June 19, 2009: TMHP will be extending prior authorizations for Total Parenteral Nutrition (TPN) to August 14, 2009. This extension affects existing prior authorizations for TPN services using procedure codes 1-S9364, 1-S9365, 1-S9366, 1-S9367, and 1-S9368 that end on June 30, 2009. Providers will be receiving a prior authorization letter from TMHP about the extension. For new prior authorizations that are requested before August 15, 2009, providers will need to request services through August 14, 2009. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Evaluation and Management Procedure Code Limitation Changes
Information posted June 19, 2009: TMHP identified an issue that impacts claims submitted with dates of service on or after May 1, 2007, through June 30, 2009, and some evaluation and management (E/M) procedure codes. Click on the title to view the details. |
| TMHP Requests Provider Feedback on Workshops
Information updated June 8, 2009: As part of the planning for 2010 provider education activities, the Texas Medicaid & Healthcare Partnership (TMHP) is asking for provider input on how educational workshops can be made more helpful to providers and their staff. Providers can give feedback to TMHP by completing a brief survey, which will be available through June 18, 2009. The survey takes about 10 minutes to complete. Click on the title to access the survey. |
| How Are Texas Medicaid and the CSHCN Services Program Different From PACT?
Information posted June 8, 2009: All services that are currently available through PACT will be available through Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program to appropriately-enrolled providers. Click on the title to view the administrative differences between PACT, Texas Medicaid, and the CSHCN Services Program.
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| TMHP Scheduled System Maintenance for June 14, 2009
Information posted June 5, 2009:TMHP will perform scheduled maintenance to the claims engine and Long Term Care (LTC) systems on Sunday, June 14, 2009, 6:00 p.m. until June 15th, 2009, 2:00 a.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Physical Medicine and Rehabilitation Benefits to Change
Information posted June 5, 2009: Effective for dates of service on or after August 1, 2009, benefit criteria for physical medicine and rehabilitation will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Outpatient Speech-Language Pathology Benefits to Change for the CSHCN Services Program
Information posted June 5, 2009: Effective for dates of service on or after August 1, 2009, benefit criteria for outpatient speech-language pathology services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Medical Direction Criteria for Anesthesia Reimbursement to Change
Information posted June 5, 2009: Effective for dates of service on or after August 1, 2009, the medical direction criteria for anesthesia reimbursement will change for Texas Medicaid. Click on the title to view the details. |
| Adding a PCCM Family Member to a Closed Primary Care Physician Panel
Information posted June 5, 2009: Reminder: TMHP cannot add new clients when the primary care provider has a closed panel. A client who selects the same primary care provider as another family member may be denied because of a closed panel. When this happens, clients are instructed to notify the primary care provider because TMHP can open a panel only at the request of a primary care provider. Click on the title to view details. |
| TMHP Wants To Hear From You - Claims and Prior Authorization Surveys
Information posted June 1, 2009: In order to provide better service to providers, the Texas Medicaid & Healthcare Partnership (TMHP) developed two surveys to find out what providers think about the claims and prior authorization transaction processes. Click on the title to access the surveys. |
| Scheduled System Maintenance for the TMHP Web Portal
Information posted June 1, 2009: Scheduled System Maintenance for the TMHP web portal is scheduled for Monday, June 1, 2009 8:00 to 9:00 p.m. During the system maintenance window, some applications related to the portal may be unavailable. TexMedConnect (Acute and Long Term Care) may have intermittent connectivity issues. Normal processing is scheduled to resume by 9:00 p.m. Click on the title to view the details. |
| July/August 2009 Texas Medicaid Bulletin No. 224
Information posted June 1, 2009: The July/August 2009 Texas Medicaid Bulletin No. 224 is now available. Click the title to view the bulletin.
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| Updated Correction: Rates Change for Medical Services, Surgical, Interpretation and Technical Codes
Information posted May 29, 2009: Effective for dates of services on or after April 1, 2009, some medical services, surgical, interpretation, and technical component procedure codes reimbursement rates have changed for the Texas Medicaid Program. The reimbursement rates were adopted following a public rate hearing that was held on February 17, 2009. Claims submitted with dates of services on or after April 1, 2009, and procedure codes T-93532 and T-93641 for the technical components may have been reimbursed at an incorrect rate. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details.
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