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 September 1, 2021, providers are no longer required to use their Texas Provider Identifiers (TPIs) for submitting paper claims and paper prior authorization requests or for calling the Texas Medicaid & Healthcare Partnership (TMHP). The TPI fields have been removed from prior authorization forms, instructions, and consent forms. In place of TPIs, providers must submit their National Provider Identifiers (NPIs) and related data on forms.
Updated Consent Forms with an Effective Date of September 1, 2021
Effective December 1, 2021, providers are allowed a grace period where TMHP will accept the previous version of the sterilization consent forms through May 31, 2022. The previous version of the English and Spanish sterilization consent forms had an effective date of April 26, 2019.
Effective June 1, 2022, only revised NPI/Atypical Provider Identifier (API)-based Sterilization Consent Forms with an effective date of September 1, 2021, will be accepted. Expired forms will be deemed grounds for final denial. If deficiencies are found with the submitted Sterilization Consent Form, TMHP will fax the provider an 838 Denial Letter with the denial and a list of items to be corrected if applicable.
For additional information related to the removal of TPIs from forms, refer to the article titled “TPI Number Removed from Medicaid Prior Authorization Forms, Instructions, and Consent Forms, Effective September 1, 2021,” which was posted on the TMHP website on September 1, 2021.
For more information, call the TMHP Contact Center at 800-925-9126.