Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.
Effective April 17, 2023, Case Management for Children and Pregnant Women (CPW) providers will submit prior authorization requests through the Texas Medicaid & Healthcare Partnership (TMHP) Prior Authorization on the Portal for fee-for-service (FFS) clients.
Providers are encouraged to visit the TMHP Prior Authorization web page. The Recent News section offers providers news and information about this change, as well as training opportunities and other prior authorization news.
In the Helpful Links section at the bottom of the TMHP Prior Authorization web page, providers can find current training materials for the Prior Authorization (PA) on the Portal Submission Guide, a general infographic about PA on the Portal, frequently asked questions, and a link to the TMHP Learning Management System (LMS), where you can access PA on the Portal computer-based training (CBT).
Providers can familiarize themselves with PA on the Portal by accessing the LMS, using the Topics drop-down menu, selecting Provider Education, and then selecting Prior Authorization.
For LMS access issues, email TMHP LMS support at TMHPTrainingSupport@tmhp.com.
Note: Updated learning materials will be published at a later date. Providers are encouraged to visit the TMHP Prior Authorization web page’s Recent News section regularly for more details.
Providers are highly recommended to participate in the TMHP Prior Authorization webinar on April 7, 2023. Details will be published soon on the Recent News section of the TMHP Prior Authorization web page.
For more information, call the TMHP Contact Center at 800-925-9126.