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Providers Must Maintain and Update Taxonomy Code Information With Information Provided to DMOs or MCOs

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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.

Providers must maintain and update their Texas Medicaid & Healthcare Partnership (TMHP) taxonomy code information with the information they provide to dental maintenance organizations (DMOs) or managed care organizations (MCOs). During enrollment, the available taxonomy code selections are auto-populated according to the provider type and specialty associated with the Texas Provider Identifier (TPI) entered on the application.

These taxonomy code options may not match the taxonomy code listed in the confirmation letter that providers have received from the National Plan and Enumeration System (NPPES) and included for MCO or DMO credentialing. For this reason, providers are encouraged to update their taxonomy codes online through the Provider Information Management System (PIMS) to align with contracted DMO or MCO programs.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.