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Medicaid PCNs Starting With “9”—Prior Authorization and Acute Care Claims Submissions

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The Texas Medicaid & Healthcare Partnership (TMHP) is aware that some newly issued Texas Medicaid patient control numbers (PCNs) appear as ineligible in certain TMHP systems. Providers that have a client who has a Medicaid PCN that begins with a “9” should check the Medicaid Client Portal to verify their client’s eligibility.

This issue has an impact on some prior authorization requests and claims for the affected clients.

Note: This issue does not impact Children with Special Health Care Needs (CSHCN) Services Program clients.

TMHP is actively working on this issue. Providers should continue to check the “Recent News” section of the TMHP website for related communications and instructions.

TMHP will publish a follow-up article when the issue is resolved.

Prior Authorization Requests

TMHP will consider retroactive authorization requests for clients who have received affected PCNs.

Providers that submit a prior authorization request for a fee-for-service client with one of the affected PCNs must fax their authorization requests and all associated documentation to TMHP. This will allow providers to meet timeliness requirements.

Important: Providers should not use PA on the Portal to submit these prior authorization requests. These requests will not progress in status in PA on the Portal until the PCN is corrected and submitted.

After TMHP has received the prior authorization request, they will contact the provider with applicable instructions. Providers will not receive a prior authorization number (PAN) but will receive a reference number, which they can use to identify the prior authorization request.

When the issue has been resolved, providers must fax the new PCN and reference number to TMHP so that the prior authorization process can be completed.

Note: Providers do not need to resubmit their prior authorization requests; they only need to fax the new PCN and corresponding reference number.

Providers can use the following fax numbers to submit their prior authorization documentation:

ContactFax Number
Ambulance Authorization (including out-of-state transfers)512-514-4205
Home Health Services512-514-4209
Comprehensive Care Program (CCP)512-514-4212
Prior Authorization Mental Health (MH)/Substance Use Disorder (SUD)512-514-4211
Outpatient Psychiatric512-514-4213
Radiology833-912-1129
TMHP Special Medical Prior Authorization (SMPA) (including transplants)512-514-4213

Claims Submissions

Currently, Medicaid fee-for-service claims submitted with a PCN that begins with “9” will be rejected. After the issue has been resolved, impacted clients will receive new PCNs and new Medicaid cards, and providers must submit claims with the new PCN. If prior authorization is required for the services rendered, the claim should be submitted once a provider has updated the client’s PCN and received a PAN. Providers can then submit the claim with the PAN and accurate PCN.

For claims for services rendered to Medicaid managed care clients with impacted PCNs, providers should submit claims directly to the managed care organization (MCO) or dental plan that administers the client’s managed care benefits. Providers do not need to wait for a new PCN if they are submitting claims directly to the MCO or dental plan.

Client Eligibility Verification

Providers can check client eligibility by using the Medicaid Client Portal or by calling TMHP at (800) 925-9126 and selecting Option 2 and then Option 4. Refer to the Medicaid Client Portal Job Aid for Providers for instructions on accessing the Medicaid Client Portal.

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