Effective September 1, 2007, the following providers will no longer need a primary care provider referral or any other type of prior authorization for services rendered to managed care clients:

·         Ophthalmologists (except for billing surgical related type of services).

·         Therapeutic optometrists that bill procedure codes 65205, 65210, 65220, 65222, 65286, 65430, 67820, 67938, 68530, 68761, 68801, 68810, and 68840.

Claims for Primary Care Case Management (PCCM) clients with dates of service between September 1, 2007, and September 28, 2007, that meet the criteria outlined above will be reprocessed 45 days after September 29, 2007, and payments will be adjusted accordingly. No action on the part of the provider is required for reprocessing. Effective for dates of service on or after September 29, 2007, claims submitted that meet the criteria outlined above will be automatically processed. No reprocessing will occur.

For health plan claim submission instructions, contact the specific health plan.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the PCCM Provider Helpline 1-888-834-7226.