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Claims Reprocessing for Some FQHC Claims

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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.

The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue that impacts claims submitted by federally qualified health center (FQHC) providers with procedure codes 90832, 92014, 92004, 92012, and 92002. The issue was fixed on March 2, 2023.

Affected claims submitted with dates of service from May 1, 2021, through March 3, 2023, may be reprocessed. When the claims are reprocessed, providers may receive additional payment, which will be reflected on Remittance and Status (R&S) Reports.

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