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Call Us: New Provider Line Options

The TMHP Contact Center is staffed with agents that are knowledgeable about Texas Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), Texas Women’s Health Program (TWHP), and Family Planning Program for both providers and clients. The Contact Center is open from 7:00 a.m. to 7:00 p.m., Central Time.

Provider Line Telephone Numbers

Main Provider Line: 1-800-925-9126

Note: The options on the main provider line have been updated to better serve providers.

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 process.

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 Procedures Manual.

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 download issues.

Option 5: Healthy Texas Women (HTW), Texas Women’s Health Program (TWHP), and Family Planning Program This Contact Center line assists with questions about the HTW, TWHP, and 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 (EVV) – 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 Numbers

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: 1-877-888-2350

This line assists clients with questions about the CSHCN Services Program and benefits.

Personal Care Services (PCS) –Durable Medical Equipment (DME) Line: 1-888-276-0702

This line assists clients with questions about PCS benefits and the Community First Choice (CFC) program.

Healthy Texas Women (HTW), Texas Women’s Health Program (TWHP), and Family Planning Program Line: 1-800-335-8957, Option 5

This line assists clients with questions about HTW, TWHP, and the Family Planning Program.