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| Correction to the New Benefits for Continuous Glucose Monitoring Article
Information posted May 9. 2008: This is a correction to an article that was posted on this website on March 10, 2008, entitled “New Benefits for Continuous Glucose Monitoring Systems.” The article stated that effective May 1, 2008, benefit changes for the continuous glucose monitoring system would be implemented for Texas Medicaid. The benefit changes for continuous glucose monitoring will be implemented on June 1, 2008. Click on the title to view the complete, corrected article. | | Correction to the New Benefits for Wearable Cardiac Defibrillators Article
Information posted May 9, 2008: This is a correction to a website article that was posted on the this website on February 11, 2008, entitled “New Benefits for Wearable Cardiac Defibrillators (WCD)” and an article that was published in the May/June 2008 Texas Medicaid Bulletin, No. 215. The articles did not include information about modifier RR when billing for a WCD lease, and incorrectly listed prior authorization requirements for the WCD. Click on the title to view the details. | | Ambulance Services to Change
Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for ambulance services will change for Texas Medicaid. Click on the title to view the details. | | Osteogenic Stimulation Benefits to Change
Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for osteogenic stimulation will change for Texas Medicaid. Click on the title to view the details. | | Second Quarter 2008 HCPCS Updates Available July 1, 2008
Information posted May 9, 2008: On July 1, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) will implement second quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after July 1, 2008. Click on the title to view the details. | | PCCM Precertification Will Not Be Required for Some Procedure Codes
Information posted May 9, 2008: Effective July 1, 2008, some procedure codes will no longer require precertification for Primary Care Case Management (PCCM) providers. Click on the title to view the details. | | Update to “Bariatric Surgery Benefits Now Available”
Information posted May 9, 2008: This is an update to an article that was posted on this website on January 9, 2008, titled, “Bariatric Surgery Benefits Now Available.” Effective for dates of service on or after July 1, 2008, bariatric surgery services will be benefits of Texas Medicaid (for clients 21 years of age and older) and the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) (for clients birth through 20 years of age). Also, the previous article incorrectly stated that procedure code 2/8/F-43845 will be a benefit. Procedure code 2/8/F-43845 is not a benefit of Medicare and will not be a benefit of Texas Medicaid. Click on the title to view the details. | | Electrodiagnostic Testing, EMG and NCS Benefit Changes Effective July 1, 2008
Information posted May 9, 2008: This is an update to articles posted on this website about new electrodiagnostic (EDX) testing benefits (including electromyography [EMG] and nerve conduction studies [NCS]) for Texas Medicaid and for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. | | New Benefit Code Helps Mental Health Providers with NPI Crosswalk
Information posted May 9, 2008: Benefit code MH2 has been created to assist with the National Provider Identifier (NPI) crosswalk solution. The new benefit code must be used by case management mental health mental retardation (MHMR) providers that submit NPI-only claims to Texas Medicaid. A benefit code is an additional data element that the Texas Medicaid & Healthcare Partnership (TMHP) uses to identify state programs.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Benefit Criteria for Anesthesia Services for Texas Medicaid to Change
Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for anesthesia will change for Texas Medicaid. Click on the title to view the details. | | Benefits for Anesthesia Services for the CSHCN Services Program to Change
Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for anesthesia will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. | | Correction to the Paper Appeals Requirements that are Effective May 23, 2008
Information posted May 9, 2008: This is a correction to an article published in the May 2008 National Provider Identifier (NPI) Special Bulletin, No. 217, entitled “Claims Submission Reminders.” Under the “Appeals” subheading, the article incorrectly indicated that providers have the option to submit appeal requests on paper for Texas Provider Identifier (TPI)-only claims that were submitted before the end of the contingency period. Click on the title to view the details. | | Providers Must Also Attest for the CSHCN Services Program
Information posted May 9, 2008: Effective May 23, 2008, National Provider Identifier (NPI) full compliance will be implemented. Claims submitted without an NPI will not be processed and will be denied. Providers that have completed the NPI attestation for Texas Medicaid must also complete the NPI attestation for the Children with Special Health Care Needs (CSHCN) Services Program. Providers that have not completed their NPI attestation will experience claim denials and rejections. Provider attestation can be completed on this website under the “I would like to” section on the right-hand side. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. | | New Banner Messages Are Available
Information posted May 9, 2008: 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. | | Neurostimulator Benefits Are Changing
Information posted May 9, 2008: Effective for dates of service on or after June 1, 2008, the benefit criteria for neurostimulators will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. | | Myocardial Perfusion Imaging Correction
Information posted May 2, 2008: This is a correction to an article posted on this website on March 10, 2008, entitled “Benefit Changes for Myocardial Perfusion Imaging.” Click on the title to view the details. | | Helicobacter Pylori (H. Pylori) 2008 TMPPM Correction
Information posted May 2, 2008: This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section 26.4.6, “Helicobacter Pylori (H.Pylori),” on page 26-6. Click on the title to view the details. | | Enhanced Services Through the PCCM+PLUS Program
Information posted May 2, 2008: Effective May 1, 2008, the Health and Human Services Commission (HHSC) and the Texas Medicaid & Healthcare Partnership (TMHP) launched Primary Care Case Management (PCCM)+PLUS. PCCM+PLUS provides enhanced services including additional care coordination services for clients who are elderly, blind, or disabled; reside in one of the 202 PCCM counties; and need additional support and care management to improve health outcomes. Clients eligible for PCCM+PLUS services are mostly adults, although children with disabilities and those who qualify for Supplemental Security Income (SSI) are also included. Click on the title to view the details. | | DME Limitations Changes for Some Codes
Information posted May 2, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue impacting claims that include any of the following procedure codes: 9-A4234, 9-A4235, 9-A4236, J-E0561, J-E0951, J-E0952, J-E0961, J-E0981, J-E0982, J-E0990, J-E0994, J-E0995, J-E0997, J-E0998, J-E0999, J-E1015, J-E1016, J-E1017, J-E1018, and J-K0733. Some limitations have changed, and claims will be reprocessed. Click on title to view the details | | Texas Medicaid National Provider Identifier (NPI) Special Bulletin No. 217
Information posted April 23, 2008: The May 2008 Special Bulletin No. 217 is now available. Click the title to view the bulletin.
| | Revised THSteps Dental Mandatory Prior Authorization Request Form
Information posted May 2, 2008: This is an update to a banner message that first appeared on the March 7, 2008, Remittance and Status (R&S) report about the revised THSteps Dental Mandatory Prior Authorization Request Form. The banner message stated that the revised form would be required effective May 1, 2008. That date has changed; TMHP will accept only the revised form effective September 1, 2008. On or before August 31, 2008, either form may be used. The banner message also stated the form would be published in May/June 2008 Texas Medicaid Bulletin, No. 215. The form was not published in this bulletin but will be published in the July/August 2008 Texas Medicaid Bulletin, No. 216. Click on the title to view the complete, revised banner message. | | Eligibility for Women's Health Program (WHP) clients for January 2008
Information posted May 2, 2008: This is an update to a website article entitled, “Eligibility for Women's Health Program (WHP) clients for January 2008” and a banner message that were published on February 15, 2008, about claims for Women's Health Program (WHP) clients whose year-long certification period expired on December 31, 2007. These clients received new identification cards in error, showing eligibility for January 2008. Click on the title to view the details. | | System Downtime Schedule for May 24, 2008
Information posted April 25, 2008: Due to the completion of the National Provider Identifier (NPI) implementation on May 23, 2008, system maintenance for the Texas Medicaid & Healthcare Partnership (TMHP) claims processing system is scheduled for Saturday, May 24, 2008, 12 a.m. to 8 p.m. During system maintenance some applications related to the claims engine will be unavailable. Click on the title to view the details. | | Scheduled System Maintenance
Information posted April 25, 2008: System maintenance for the Texas Medicaid & Healthcare Partnership (TMHP) claims processing system is scheduled for Sunday, May 11, 2008, 6:00 p.m. to 11:59 p.m. During system maintenance some applications related to the claims engine will be unavailable. This downtime is a replacement to the Extended Yearly Memorial Day system maintenance window previously scheduled for May 25, 2008, through May 26, 2008, (3 p.m. on Sunday to 6 p.m. on Monday), which will be canceled. Click on the title to view the details. | | Refunds to TMHP Reminder
Information posted April 25, 2008: Reminder: As indicated in the 2008 Texas Medicaid Provider Procedure Manual, Section 6.2, “Refunds,” on page 6-4 and Section 4.10.6, “Refunds to TMHP Resulting from Other Insurance Payments and Conditions Surrounding Provider Billing of Third Party Insurers,” on page 4-15, providers are prohibited from receiving payment from Medicaid, billing a third-party resource (TPR), and then refunding the lesser of the two payments to Medicaid. The Texas Medicaid & Healthcare Partnership (TMHP) Cash Reimbursement Unit is responsible for processing financial adjustments when any of the following occur: overpayment, duplicate payment, payment to incorrect providers, and overlapping payments by Medicaid and a TPR. Click on the title to view the details. | | Reconstructive Finger Surgery
Information posted April 25, 2008: Effective for dates of service on or after May 1, 2008, procedure code F-26587 is a benefit when performed at ambulatory surgical centers (ASC) and hospital ambulatory surgical centers (HASC). Procedure code F-26587 is reimbursed under ASC Group 5.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
| | Provider Enrollment Online for Primary Care Case Management (PCCM) Providers
Information posted April 25, 2008: Beginning April 29, 2008, PCCM providers and potential PCCM providers can enroll on this website. Click on the title to view the details. | | Online Provider Enrollment Systems Maintenance Scheduled For April 24, 2008
Information posted April 23, 2008: TMHP will perform maintenance to the online provider enrollment system on April 24, 2008, from 7:00 p.m. until 8:00 p.m. Central Time. Online provider enrollment will not be available during this time period. | | Nonemergency Ambulance Transport Prior Authorization Available 24 Hours a day
Information posted April 25, 2008: Effective June 29, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) will begin receiving and processing certain telephone prior authorization requests for nonemergency ambulance transports 24 hours a day, including weekends and holidays. Click on the title to view the details. | | May 2008 Long Term Bulletin No. 34
Information posted April 25, 2008: The May 2008 Long Term Bulletin No. 34 is now available. Click the title to view the bulletin.
| | Health Insurance Premium Payment (HIPP) Program
Information posted April 25, 2008: The Health Insurance Premium Payment (HIPP) Program reimburses for the cost of medical insurance premiums. An individual is eligible for the HIPP Program when Medicaid finds it more cost effective to reimburse for an individual’s private health insurance premiums than to reimburse his or her medical bills directly through Medicaid. Click on the title to view the details. | | Family Planning Benefits and Reimbursement Updates for Titles V, X, and XX
Information posted April 25, 2008: Effective for dates of service on or after May 1, 2008, the following benefit changes have been implemented for the Titles V, X, and XX family planning program. Click on the title to view details. | | Discontinued Procedure Codes
Information posted April 25, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue regarding procedure codes that remained payable in the claims system after the procedure code had been discontinued. These codes were also published in the fee schedules on this website. Click on the title to view the details. |
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