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.
This is a clarification for providers whose processed claims displayed an extra detail line. The affected claims were between April and May 2021. This detail line displays $0.00 charge amount and $0.00 paid amount and may display denial explanation of benefits. This extra detail line was inserted due to a temporary system issue, but it does not change the overall disposition of the claim or the claim payment.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.