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Update to Timeframe Requirements for Provider Maintenance Files

Last updated on 10/24/2019

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Beginning November 1, 2019, TMHP will update the Texas Medicaid Provider Procedures Manual Volume 1: Section 1, Provider Enrollment and Responsibilities and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Chapter 2: Provider Enrollment and Responsibilities, to align with Title 1 Texas Administrative Code (TAC) §352.21, “Duty to Report Changes.”

The timeframe requirement for reporting provider maintenance changes will be updated to 90 days. Failure to provide this information within 90 days may lead to administrative action by HHSC.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.