Main Provider Line: 1-800-925-9126
Note: The options on the main provider line have been updated to better serve
This provider line offers general
information concerning Texas Medicaid. Responsibilities include policy
education, claims filing assistance, financial inquiry, eligibility inquiry, and
provider education. The following options are available:
Option 1: Automated transactions
– Choose this option for automated transactions available through the Automated
Inquiry System (AIS).
Option 2: Provider Inquiries – Choose one of the following options:
Option 1: Client Eligibility
– This line assists providers with questions about current and past eligibility
for Medicaid clients.
Option 2: Claims Status –
This line assists providers with claim related inquires, such as claim status,
appeal process, and claim submission instruction.
Option 3: Authorizations
– This line assists providers with prior authorization request concerns,
including appropriate submission format, instruction clarification, and appeal
Option 4: Telephone Appeals –
This line is available for providers to request a claim appeal. The provider
must have the most recent 24-digit claim number, and the appeal process is
limited to specific claim situations. Telephone appeals must follow the
guidelines in the Texas Medicaid Provider
Option 5: Benefit Limitations and Dental History –This line assists
providers with questions related to benefit limitations for Medicaid services.
This line also assists with client dental history.
Option 6: Accounts Receivable and Financial Transactions –
This line assists providers with questions regarding accounts receivable,
payment status, and check history.
Option 3: Provider Enrollment –
The Provider Enrollment line assists with applications to enroll, updates to new
and existing provider accounts, and questions concerning enrollment policy. Some
of the responsibilities include the following: maintenance of provider accounts,
advising providers on how to complete a Texas Medicaid program application, and
answering questions regarding policies which impact enrollment.
Option 4: Electronic Data
Interchange (EDI) –
The EDI Help Desk assists providers and vendors with TexMedConnect (TMC) access.
The Help desk can reset TMC passwords and troubleshoot other TMC and EDI issues,
such as Internet requirements, EDI enrollments, transmission verifications, TMC
issues, file rejections, software requests, file resets, technical problems
within the TMHP website, and electronic Remittance and Status (ER&S) Report
Option 5: Healthy Texas Women (HTW) and
the Family Planning Program
This Contact Center line assists with questions about the HTW and the Family
Planning Programs, such as policies, benefits, and prior authorizations.
Option 6: Electronic Health Records (EHR) Incentive Program
This line assists providers who have questions about the EHR incentive program
that is available for eligible Medicaid providers.
Option 7: Electronic Visit Verification
This line assists providers who have questions about EVV.
Option 8: Third Party Resource (TPR) –
This line assists with questions regarding a
Medicaid client’s other insurance information. Some of the responsibilities
include other insurance verification and other insurance updates.
Children with Special Health Care Needs Services Program: 1-800-568-2413
This is a general inquiry line concerning the Children with Special Health Care
Needs (CSHCN) Services Program. These Contact Center representatives answer
questions and resolve issues for all matters concerning this program.
Responsibilities include claim research, prior authorization information,
policy, and billing.
Option 1: Automated inquiries
Option 2: Enrollment
Option 3: Authorizations
Client Line Telephone
Client Hotline: 1-800-335-8957
The Client Hotline handles client issues pertaining to the status of Medically
Needy cases, billing questions, Medicaid program benefits, as well as contact
information for the Medical Transportation Program services, Texas Health Steps
(THSteps) services, and Health Insurance Portability and Accountability Act
(HIPAA) privacy violations.
Client Notification: 1-800-414-3406
This line assists clients with questions about authorization requests that have
been modified or denied for one of the following reasons: not meeting medical
necessity criteria, incomplete requests, submission guidelines, or lacking
Federal Financial Participation. The agents are responsible for educating the
client on the review process when a prior authorization request has been denied.
Health Insurance Portability and Accountability Act (HIPAA): 1-800-723-4789
This line assists clients with questions about HIPAA Certificates they may have
received. These certificates are provided to inform clients that their Medicaid
coverage has ended. A replacement certificate can be requested if needed.
Children with Special Health Care Needs (CSHCN) Services Program Client Line:
This line assists clients with questions about the CSHCN Services Program and
Personal Care Services (PCS) –Durable Medical Equipment (DME) Line:
This line assists clients with questions about PCS benefits and the Community
First Choice (CFC) program.
Healthy Texas Women (HTW) and Family
Planning Program Line: 1-800-335-8957, Option 5
This line assists clients with questions about HTW and the Family