Information posted July 17, 2020
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.
Effective for dates of service on or after September 1, 2020, prior authorization language will be updated for genetic testing for colorectal cancer.
A completed Special Medical Authorization Request Form must be signed, dated, and submitted by the provider rendering direct care. Requests from laboratories will not be processed.
The provider should then share the authorization number with the laboratory submitting the claim.
For more information, call the TMHP Contact Center at 800-925-9126.