Optometry and Ophthalmology Claims Reprocessing for PCCM Providers

Information posted December 23, 2008: TMHP has identified an issue affecting non-surgical claims submitted by optometrists and ophthalmologists with dates of service on or after September 1, 2007, for Primary Care Case Management (PCCM) clients. These claims may have been inappropriately denied because of a missing primary care provider referral. Primary care provider referrals are not required for routine vision services. Affected claims will be reprocessed beginning on January 12, 2009. Payments will be adjusted accordingly. No action on the part of the provider is necessary. For more information, call the TMHP Contact Center at 1-800-925-9126.