To help ensure continuity of care during the COVID-19 (coronavirus) response, the Health and Human Services Commission will allow TMHP to extend for 90 days existing prior authorization requests that are set to expire through November 30, 2020, if providers are unavailable or unable to provide the required documentation on a timely basis due to a COVID-19 related issue.
Note: Providers currently have the option to request prior authorization time periods other than the 90-day extension.
For new and initial prior authorization requests, and for recertifications of existing prior authorizations, providers should refer to the TMHP COVID-19 webpage and the COVID-19 Guidance for New and Initial Prior Authorizations.
Providers will need to continue to alert TMHP of which option they wish to pursue. TMHP may request additional information, if it is deemed necessary, but will not deny prior authorization requests if providers are unavailable or unable to provide required documentation on a timely basis.
It is expected that before reimbursement is requested, the provider has obtained the appropriate required documentation for inclusion in the client’s file. The services delivered may still be subject to retrospective review for medical necessity. Exceptions will be reviewed on a provider- or recipient-specific basis and need.
Fee-for-service providers should contact the TMHP Contact Center at 800-925-9126 if they have questions or need other information about providing Texas Medicaid services. For recipients enrolled in managed care, providers should contact the MCO for additional guidance.