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Update to “Signature Updates to Home Health Prior Authorization Request Forms”

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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.

This is an update to the article titled ”Signature Updates to Home Health Prior Authorization Request Forms,which was published on the Texas Medicaid & Healthcare Partnership (TMHP) website on June 22, 2023.

TMHP will continue to accept older home health prior authorization forms for 90 days after July 1, 2023, instead of 30 days, as stated in the previous notification. After this transition period ends, only the updated forms will be accepted.

Important: Beginning September 30, 2023, previous versions of the home health prior authorization forms will be returned to providers, resulting in a delay in the authorization approval process.

Forms are available under the Resources tab (click on ‘Forms’) and under the Topics tab (click on ‘Prior Authorization’) in the TMHP website.

Note: When submitting a prior authorization request, the ordering or prescribing physician assistant (PA), certified nurse practitioner (CNP), or clinical nurse specialist (CNS) must include their own National Provider Identifier (NPI) in the request instead of the group’s or physician’s NPI. Prior authorizations without the correct NPI will be returned as incomplete.

For more information, call the TMHP Contact Center at 800-925-9126.