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.
Effective October 1, 2023, the fourth quarter National Correct Coding Initiative (NCCI) updates will be implemented for claims processed by the Texas Medicaid & Healthcare Partnership (TMHP) for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
Providers may refer to the Centers for Medicare & Medicaid Services (CMS) Medicaid NCCI web page for updated Medicaid NCCI rules, relationships, and general information. A link to the CMS Medicaid NCCI web page 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.