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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.

 
   
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