Skip to main content

Update to ‘TMHP to Revert Back to Grouper Version 36 of the APR-DRG System to Process Inpatient Claims’

Last updated on

This is an update to the article titled, “TMHP to Revert Back to Grouper Version 36 of the APR-DRG System to Process Inpatient Claims,” which was published on this website on November 24, 2020.

The Texas Health and Human Services Commission (HHSC) published a Frequently Asked Questions (FAQ) document on its website to further address questions from the provider community regarding the previously mentioned article. Providers can access the FAQ and other information for APR-DRG on HHSC’s website by clicking here.

Managed Care Providers

Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.