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Online Fee Lookup Update: “Not Payable” Message to Change to “Payable at Contracted Rate” for Services Payable at a Contracted Rate

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Note: 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.

Effective January 15, 2021, the Online Fee Lookup will be updated to display the message “Payable at Contracted Rate,” instead of “Not Payable,” for searches for outpatient claims paid to providers who receive a contracted rate.

For more information, call the TMHP Contact Center at 800-925-9126.