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Contact Center Telephone Numbers
The Contact Center is staffed
with agents that are knowledgeable about
Medicaid, Children with Special Healthcare Needs (CSHCN)
and the Family Planning Programs and is
accessible by phone, email, or web chat. The
Contact Center is open from 7 a.m. to 7 p.m.
Central Time and can be reached at the numbers
listed below.
Provider
Lines
General Inquiries Line:
1-800-925-9126
This is a provider line
responsible for assisting with
issues not addressed by other
available provider lines. The
Contact Center Representative
provides general information
concerning the Texas Medicaid
Program. Responsibilities
include policy education, claims
filing assistance, financial
inquiries, eligibility inquiry,
Title XIX Family Planning, and
provider education.
Ambulance: 1-800-925-9126,
Option 3
This Contact Center queue
handles questions regarding
claims, non-emergency ambulance
prior authorizations, emergency
transports, and informs provider
of billing information
concerning the Ambulance
Program.
Electronic Health
Records (EHR) Incentive Payment Program: 1-800-925-9126, Option 4
This line assists providers
who have questions about the EHR incentive program that is available for
eligible Medicaid providers.
Provider Enrollment:
1-800-925-9126, Option 2
The Provider Enrollment queue is
designed to assist providers
with applications to enroll and
update new and existing provider
accounts, and questions
concerning enrollment policy.
Some of the responsibilities
include: maintenance of provider
accounts, advising providers on
how to complete a Texas Medicaid
program application, and
answering questions regarding
policies which impact
enrollment.
Children with Special Health
Care Needs: 1-800-568-2413
This is a general inquiry line
concerning the Children with
Special Health Care Needs
program. The Contact Center
Representatives on this line
answer questions and resolve
issues for all matters
concerning this program.
Responsibilities include: claim
research, prior authorization
information, policy, and billing
information.
Texas Health Steps Medical:
1-800-757-5691
This line is set up for
questions concerning the Texas
Health Steps Medical plan,
specific to the program
administration for children
under the age of 21.
Responsibilities include: Texas
Health Steps Medical program
information, billing
information, appeals and benefit
limitations concerning the
periodicity schedule.
Texas Health Steps
Dental:1-800-568-2460
This queue acts as a customer
service and appeal line for all
providers specific to Dental
claims and policy issues.
Responsibilities include:
general inquiry, benefit
limitations, and Dental claim
appeals.
Comprehensive Care Program
(CCP)/ Home Health Line:
1-800-846-7470
Durable Medical Equipment (DME),
Home Health, and CCP providers
use this line for authorization
related inquiry.
Responsibilities entail prior
authorization information,
researching Title XIX forms, and
benefit limitation questions.
EDI Helpdesk:
1-888-863-3638
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
enrollment, transmission
verification, TMC issues, file
rejection, software requests,
file resets, technical problems
within the TMHP website, and
ER&S download issues.
Third Party Resources:
1-800-846-7307
This queue is for the providers
to update other insurance information concerning
a client's Medicaid account. The Contact Center
Representatives' responsibilities include: other
insurance verification, and other insurance
updates.
Telephone Appeals:
1-800-745-4452
This line is available for
providers to call and request
claims to be appealed. The
provider must have the most
recent 24 digit claim number,
and is limited to specific claim
situations. Telephone appeals
must follow the guidelines in
the Texas Medicaid Provider
Procedures Manual, Section
5.1.2.4.
Client Lines
Client Hotline: 1-800-335-8957
and 1-800-252-8263
The Client Hotline handles
Medicaid client issues
pertaining to the status of
Medically Needy cases, billing
questions, and Medicaid program
benefits, as well as contact
information for the Medical
Transportation Program, THSteps
services, and for HIPAA privacy
violations. Clients should still
contact the PCCM Client Helpline
for assistance at 1-888-302-6688
Client Notification:
1-800-414-3406
This line offers clients
assistance with an authorization
request that has been modified
or denied for one of the
following reasons: 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 has been denied.
They will also gather the
required documentation to be
reviewed during the Fair
Hearing.
HIPAA:1-800-723-4789
This line is provided to assist
clients by offering an
explanation on HIPAA
Certificates. These certificates
are provided to inform clients
that their Medicaid coverage has
ended. A replacement certificate
can be requested if needed.