Providers can submit complaints as follows:

When a complaint is lodged by telephone, providers should document and retain the ticket number supplied by the Contact Center representative.

The TMHP Complaints Resolution Department researches and, if possible, resolves provider complaints without contacting the provider. If contacting the provider to obtain additional information is needed to resolve the complaint, the TMHP Complaints Resolution Department sends an acknowledgement letter to the provider within five business days of the complaint receipt date. The acknowledgement letter refers to the ticket number supplied by the Contact Center representative and tells the provider the information to submit so that TMHP can resolve the complaint. 

Providers that believe their complaint did not receive due process from TMHP may file a complaint with the Texas Health and Human Services Commission (HHSC). Providers are encouraged to use the appeals/grievance process with TMHP before filing a complaint with HHSC. 

For detailed information about the provider complaints procedure, providers can refer to the 2009 Texas Medicaid Provider Procedures Manual, sections 6.3.5 and 7.7.20.2, “Provider Complaints,” sections 7.1.9, “Medicaid Managed Care Complaints and Fair Hearings,” and 6.3.6 “Complaints to HHSC-Texas Medicaid Fee-for-Service and PCCM.”

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