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New National POS 27 and Update to Local POS 2 for Texas Medicaid and CSHCN Claim Systems

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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.

Beginning February 10, 2024, and effective for dates of service on or after October 1, 2023, the national place of service (POS) code 27 (outreach site/street) will be added to crosswalk to POS code 2 (home). The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims.

This update will be reflected in the POS identification table in the Texas Medicaid Provider Procedures Manual (TMPPM), Section 6: Claims Filing, on March 1, 2024, and in the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Chapter 5: Claims Filing, Third-Party Resources, and Reimbursement, and Chapter 9: Ambulance, on March 15, 2024.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.