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The TMHP Contact Center is staffed with agents that are knowledgeable about Texas Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW) and the Family Planning Program. The Contact Center is open from 7:00 a.m. to 7:00 p.m., Central Time, and can assist both providers and clients. Send us an email by clicking the button below, or select from one of the available telephone lines.

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General Inquiries: 

This provider line offers general information concerning Texas Medicaid, Texas Healthy Women, and the Family Planning Program. Agents can assist with claims filing, financial inquiries, eligibility, and provider education. The following options are available:

Option 1: Automated transactions. For a menu of automated information available through the AIS system.

Option 2: Provider Inquiries. select one of the following options:

Option 1: Claims Status. This line assists providers with claim related inquires, such as claim status, appeal process, and claim submission instruction.

Option 2: Authorizations. For questions about prior authorization requests, including appropriate submission format, instruction clarification, and the appeal process.

Option 3: Telephone Appeals. For submitting a claim appeal via phone. For applicable claims refer to the Texas Medicaid Provider Procedures Manual.

Option 4: Benefit Limitations and Dental History. For questions about benefit limitations for Medicaid services and client dental history.

Option 5: Accounts Receivable and Financial Transactions. For accounts receivable, payment status, and check history information.

Option 3: Provider Enrollment. For assistance with enrollment applications, updates to new and existing provider accounts, and enrollment policy. Agents can answer questions about maintenance of provider accounts, completing a Texas Medicaid program application, and policies that affect enrollment.

Option 4: Electronic Data Interchange (EDI). For EDI Help Desk assistance with TexMedConnect access and EDI issues, such as: resetting passwords, Internet requirements, EDI enrollments, transmission verifications, file rejections, software requests, file resets, technical problems within the TMHP website, and electronic Remittance and Status (ER&S) Report downloads.

Option 5: Healthy Texas Women (HTW) and the Family Planning Program.For questions about the HTW and the Family Planning Programs, such as policies, benefits, and prior authorizations.

Option 6: Electronic Visit Verification (EVV). For questions about EVV.

Option 7: Third Party Resource (TPR). For questions about a Medicaid client’s other insurance information, assistance with other insurance verification, and other insurance updates. TPR is open from 8:00 a.m. to 5:00 p.m., Central Time.

CSHCN Services Program:  

CSHCN Services Program providers can call this line for assistance from 7:00 a.m. to 7:00 p.m., Central Time. Representatives are ready to answer questions and resolve issues for all CSHCN Services Program matters. Representatives will assist with claim research, prior authorization information, policy, and billing.

Providers can choose from the following options:

Option 1: Automated inquiries. For a menu of automated information available through the AIS system.

Option 2: Enrollment. For questions about provider enrollment.

Option 3: Authorizations. For questions about authorization and prior authorization requests.

Long Term Care Program:  
800-626-4117 or 800-727-5436

Providers can choose from the following options:

Option 1: General inquiries. For general inquiries and information about LTC claims, verification, and nursing facility forms.

Option 2: Nurse. For inquiries requiring the assistance of a TMHP nurse.

Option 3: Electronic Data Interchange (EDI) Help Desk. For assistance with technical questions.

Option 4: Electronic Visit Verification (EVV). For questions about EVV.

Option 5: Fair Hearing. To request a fair hearing.

Option 6: Other Insurance. For answers to questions about other insurance information and updates.