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Update to ‘New HTW Provider Certification Requirements’

Last updated on 6/14/2021

This is an update to an article that was published on the TMHP website on April 26, 2021, titled “New HTW Provider Certification Requirements.” Effective for dates of service on or after August 1, 2021, in addition to the providers that are currently required to complete a Healthy Texas Women (HTW) certification, most provider types and provider specialties will also be required to complete a HTW certification to be reimbursed for HTW services.

Providers enrolled in Medicaid as one of these provider types and specialties, but choose not to complete the certification, will not be reimbursed for HTW services provided on or after August 1, 2021. Providers that complete the certification after August 1, 2021 will be reimbursed for HTW services provided on or after their certification date.

The following HTW providers are exempt from the HTW certification requirement, but they must still comply with HTW program policy to be reimbursed:

  • Independent laboratories
  • Radiology providers
  • Teaching hospitals

Note: Providers that have a current HTW certification on file do not need to take any action.

Some HTW claims submitted with dates of service from June 1, 2021, through June 11, 2021, may have been denied because an HTW certification was not on file for the provider. Affected claims will be reprocessed and providers might see an additional payment on their Remittance and Status (R&S) report.

Providers can use the Provider Information Management System (PIMS) to complete the certification by August 1. For more information about using PIMS, providers can refer to the Provider Information Management System (PIMS) Instructions for HTW Certification and Attestation.

For more information about HTW provider policies, including provider enrollment and the HTW certification, providers can refer to the current Texas Medicaid Provider Procedures Manual, Healthy Texas Women Program Handbook, section 2.1 Guidelines for HTW Providers and section 2.2 HTW Provider Enrollment.

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