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.
Starting Monday, April 17, 2023, Case Management for Children and Pregnant Women (CPW) providers will submit prior authorization requests through the Texas Medicaid and Healthcare Partnership (TMHP) Prior Authorization (PA) on the Portal for fee-for-service (FFS) clients.
New CPW Forms Will Be Available
The following new CPW prior authorization forms will be available on the TMHP website and through PA on the Portal:
- Form F00186, which will be used for initial requests
- Form F00187, which will be used for additional visit requests
Register Now for the Upcoming Webinar
To prepare for this change, TMHP urges providers to attend the prior authorization webinar on April 7, 2023, from 11 a.m. to noon.
Visit the TMHP prior authorization webinar web page to register.
The webinar will cover the following topics:
- Prior authorization guidelines for Medicaid providers
- Best practices for submitting prior authorization requests
- How to access PA on the Portal and additional training resources
Before attending this webinar, providers should complete the new PA on the Portal computer-based training (CBT), which can be found on the Learning Management System (LMS).
Find PA on the Portal in the LMS
To locate the PA on the Portal CBT:
- Log into the LMS.
- Type “PA on the Portal” into the LMS search bar.
- Click the PA on the Portal CBT link.
Note: If you’re new to the LMS, you can create an account or browse the LMS as a guest.
For more information, call the TMHP Contact Center at 800-925-9126.