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.
There will be no updates to the National Correct Coding Initiative (NCCI) files for the second quarter of 2023. Providers must continue to follow the NCCI rules and guidelines from the first quarter updates effective January 1, 2023.
Providers may refer to the Centers for Medicare & Medicaid Services (CMS) website for updated Medicaid NCCI rules, relationships, and general information. A link to the CMS Medicaid NCCI website is also available on the Rate and Code Updates – NCCI Updates web page on tmhp.com.
Providers are encouraged to monitor the CMS website regularly for updates to Medicaid NCCI rules and guidelines.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.