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.
Following existing submission guidelines found in the Texas Medicaid Provider Procedures Manual (TMPPM), Vol. 1 Fee-for-Service Prior Authorizations, section 18.104.22.168, “Documentation Requirements and Retention,” the Texas Medicaid & Healthcare Partnership (TMHP) requires providers to include a valid date in the Month/Day/Year format on all corresponding date fields within prior authorization forms.
All prior authorization forms must be completed and signed before the prior authorization request is submitted to TMHP. TMHP will not accept prior authorization forms that are dated after the request has been submitted (i.e., post- or future-dated). For example, if the prior authorization is submitted on 11/28/2023, then dates cannot be listed as 11/29/2023 or later.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.