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 October 1, 2020, the fourth quarter 2020 National Correct Coding Initiative (NCCI) updates will be implemented for claims processed by TMHP for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
Providers may refer to the Centers for Medicare & Medicaid Services (CMS) website at medicaid.gov/medicaid/program-integrity/ncci/index.html for the updated Medicaid NCCI rules, relationships, and general information. A link to the CMS Medicaid NCCI website is also available on the Rate and Code Updates – NCCI Updates web page on TMHP.com.
Reminder: In instances when medical policy is more restrictive than NCCI or Medically Unlikely Edits (MUE) guidance, medical policy prevails.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.