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Updates About Using 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.

The Texas Medicaid & Healthcare Partnership (TMHP) will accept outdated prior authorization forms that do not impact clinical review until June 30, 2024. Effective July 1, 2024, only the updated form will be accepted.

Note: Forms that contain TPI fields cannot be submitted because they are out of date and have a negative impact on prior authorization creation.

In the future, the standard 30-day grace period that follows form updates will be increased to a standard 90-day grace period. After this period, requests that are submitted with outdated forms will be denied. This increase will allow submitters time to update their systems and processes to use the most current form.

Forms are available under the Resources tab (click Forms) and under the Topics tab (click Prior Authorization) on tmhp.com.

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