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Prior Authorization DOS Calculator Now Available

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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 dates of service (DOS) calculator has been added to the Prior Authorization web page on tmhp.com. Providers should use the calculator to calculate the DOS that must be applied to the prior authorization form/prior authorization request.

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