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 May 6, 2021, for dates of service on or after April 1, 2021, the reimbursement rates for some drugs procedure codes will be updated.
The following link shows the updates: Drugs
Affected claims with dates of service from April 1, 2021, through May 6, 2021, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.
For more information, call the TMHP Contact Center at 800-925-9126.