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 an update to the article titled “Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021,” which was posted on this website on August 16, 2021.
The update is that providers should stop using Texas Provider Identifiers (TPIs) by December 1, 2021.
To promote a smooth transition as the TPI is phased out, TMHP will continue to accept older forms that include TPIs after September 1, 2021, until November 30, 2021. After this transition period ends, only the revised NPI/API-based forms will be accepted.
Important: Beginning December 1, 2021, forms with TPIs will be returned, resulting in a delay in authorization approval or service reimbursement.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.