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.
Beginning October 1, 2023, the national place of service (POS) code 10 (telehealth services for patients at home) will be updated to crosswalk to POS code 1 (office). The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any claims that are identified with dates of service on or after January 1, 2022. Providers only have to appeal claims if the claims are denied for additional reasons after reprocessing is completed.
This update will be reflected in the POS identification table in the Texas Medicaid Provider Procedures Manual (TMPPM), Claims Filing Handbook on November 1, 2023 and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement on November 15, 2023.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.