TMHP and HHSC Contact Information
1.1TMHP-CSHCN Services Program Contact Information
1.1.1CSHCN Services Program Telephone and Fax Communication
Contact | Telephone and Fax Number |
|---|---|
TMHP-CSHCN Prior Authorization and Authorization Fax | 1-512-514-4222 |
Provider Enrollment Fax | 1-512-514-4214 |
Provider Enrollment Phone | 1-800-568-2413, Option 2 |
CSHCN Services Program Helpline | 1-800-252-8023, Option 2 |
TMHP Electronic Data Interchange (EDI) Help Desk | 1-888-863-3638, Option 4 |
TMHP EDI Help Desk Fax | 1-512-514-4228 |
Third-Party Resource (TPR) Phone | 1-800-846-7307 |
TPR Fax | 1-512-514-4225 |
Appeal Submission through AIS Line | 1-800-568-2413, Option 1 |
CSHCN Services Program Complaints Unit Fax | 1-512-776-7238 |
1.1.2Written Communication with CSHCN Services Program
Correspondence | Address |
|---|---|
First-Time Claims (Resubmit all “Zero Allowed, Zero Paid” claims. Resubmit claims originally denied as an “Incomplete Claim” on an R&S Report) | Texas Medicaid & Healthcare Partnership |
Appeals and Adjustments | Texas Medicaid & Healthcare Partnership |
Provider Complaints | CSHCN Services Program |
Prior Authorization and Authorization | Texas Medicaid & Healthcare Partnership |
Enrollment | Texas Medicaid & Healthcare Partnership |
Third-Party Resource | Texas Medicaid & Healthcare Partnership |
Electronic Claims and Rejected Reports (Past the 95-day filing deadline) | Texas Medicaid & Healthcare Partnership |
Other Correspondence (Must be directed to a specific department or individual) | Texas Medicaid & Healthcare Partnership |
1.1.3TMHP-CSHCN Services Program Contact Center
The TMHP-CSHCN Services Program Contact Center at 1-800-568-2413 is available Monday through Friday from 7 a.m. to 7 p.m., Central Time, and is the main point of contact for the CSHCN Services Program provider community.
1.1.4TMHP-CSHCN Services Program Automated Inquiry System (AIS)
Dial 1-800-568-2413 (toll-free) to access the TMHP-CSHCN Services Program AIS. The call is answered automatically. Providers should follow the directions to access AIS and use the automated features to obtain information and services.
The TMHP-CSHCN Services Program AIS provides the following information and services through the use of a touch-tone telephone: claim status, client eligibility, current weekly payment amount, faxed forms, and claim appeals.
The TMHP-CSHCN Services Program AIS eligibility and claim status information is available 23 hours a day, 7 days a week with scheduled down time between 3 a.m. and 4 a.m., Central Time. All other AIS information is available Monday through Friday from 7 a.m. until 7 p.m., Central Time. AIS offers 15 transactions per call.
Note:Pressing Star then Pound (*#) repeats any information given. Pressing Star then Star (**) begins again if an error was made. Pressing Zero then Pound (0#) at any time repeats the main menu.
Note:All users who access www.tmhp.com are required to accept the American Medical Association (AMA) End-user Agreement on the use of Current Procedural Terminology (CPT). For each computer that accesses the TMHP website, the agreement must be accepted every 30 days from the last date on which the agreement was accepted by the user. If the end-user agreement is not accepted on a particular computer every 30 days, no user will be able to enter the website from that computer.
Refer to: https://www.ama-assn.org/practice-management/cpt/cpt-overview-and-code-approval
1.1.5TMHP Regional Representatives
The TMHP Provider Relations Department comprises a staff of Austin-based and field-based provider relations representatives who serve the health-care community by furnishing a variety of services and activities designed to inform and educate health-care providers about the CSHCN Services Program policies and claims filing procedures.
Provider Relations activities include the following:
•Provider education through planned events. Provider representatives conduct a planned program of educational workshops, webinars, computer-based training (CBT), in-services, and training sessions designed to keep all actively-enrolled providers informed of the latest policies, claim processing procedures, and federal and state regulations affecting CSHCN Services Program. Technical support and training are also provided to TexMedConnect software users.
•Problem identification and resolution. A staff of research coordinators is available to assist providers with clarification of Medicaid policies and assist with in-depth problem claim submission issues after initial inquiries are made with the CSHCN Contact Center. Coordinators work closely with field-based regional representatives to coordinate the educational needs of the community.
•Relationship with professional health-care organizations. To ensure that Texas associations that represent health-care professions have up-to-date information about the requirements for participation in the CSHCN Services Program, the Provider Relations Department maintains a working relationship with these organizations. Also, the Provider Relations Department participates in several events sponsored by Texas health-care associations, such as conventions and conferences.
Providers must call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413 to speak to a representative who can answer questions.
If the Contact Center representative determines that an inquiry can best be handled by the TMHP Provider Relations department, the inquiry will be forwarded to Provider Relations. For example, providers who want to talk to their Provider Relations representative about a visit, in-service, or training, can call the Contact Center, and the Contact Center will forward the request to Provider Relations.
Provider relations representatives, the area they serve and additional information, including a regional listing by county and workshop information, is available on the TMHP website at www.tmhp.com/resources/provider-support-services.
The TMHP website at www.tmhp.com is a valuable resource that provides:
•Information and registration for upcoming provider education and training sessions.
•A file library of publications, such as bulletins, banner messages, and provider manuals.
•Announcements of current and upcoming program changes and other important information.
•A chatbot for frequently asked questions and a live chat to speak with an agent.
Additional advanced features are available for providers that create an account. There is no charge for creating an account on the TMHP website. All enrolled providers are eligible for this service. Once an account has been created, providers have access to:
•Texas Medicaid and the CSHCN Services Program enrollment information.
•Claim Status Inquiry (CSI).
•Eligibility verification (EV).
•Electronic Remittance and Status (ER&S) Report download option.
•Complete instructions for setting up a Provider Administrator account and the use of online CSI, EV, and ER&S Reports.
•E-mail the TMHP-CSHCN Services Program Contact Center.
•Workshop registration.
•Claim submission.
•Claim appeals.
•View the new provider welcome.
New services continue to be added to the website. Visit the TMHP website at www.tmhp.com or call the Electronic Data Interchange (EDI) Help Desk at 1-888-863-3638 for the latest information about online services.
Refer to: The TMHP website at www.tmhp.com for further details and instructions on how to submit claims on the website.
1.2.1Publications
All providers have access to the publications available on the TMHP website, including:
•Banner messages—a weekly history of banner messages.
•EDI reference and connectivity guides.
•Fee schedules.
•Provider manuals.
The online version of the CSHCN Services Program Provider Manual is available in portable document format (PDF), which can be viewed in Adobe® Acrobat® or Reader®. The Bookmarks window located on the left side of the screen provides a link to each heading within the manual. Click on the heading or link to quickly access the topic of interest.
Providers can use the following instructions to search the online version of the manual by a keyword or phrase:
1)Click the Search icon (binoculars) in the toolbar located at the top of the page. The Acrobat Find window opens.
2)In the Find What window, enter a keyword or phrase. Choose one of the following options, if applicable to the search:
•Whole word only
•Case-Sensitive
•Include Bookmarks
•Include Comments
3)Click Search. The cursor moves to the first place within the manual where the word or phrase appears. Instances found are listed in the Results window.
4)To search for a different keyword or term, click the New Search icon and type in the keyword or term and click Search.
1.3CSHCN Services Program Central and Regional Offices
1.3.1Central Office
The central offices of the CSHCN Services Program are administratively located within the Office of Primary and Specialty Health, Health & Developmental Services section of the division for Health, Developmental & Independence Services, at the Health and Human Services Commission (HHSC).
TMHP is the claims administrator, and questions concerning provider enrollment, benefits or coverage, claims processing, and authorizations or prior authorizations should be directed to TMHP. DSHS-CSHCN Services Program welcomes provider comments and suggestions.
Providers can contact the CSHCN Services Program using the following information:
•Telephone toll-free at 1-800-252-8023 (may be used only in Texas) or the Austin local number at 1-512-776-7355
•Fax to CSHCN Services Program at 1-512-776-7162 or the Austin local number at 1-512-776-7238
•Send email to cshcn@dshs.texas.gov
Providers of Family Support Services (e.g., respite care, home and vehicle modification) are enrolled and reimbursed by the CSHCN Services Program. Enrollment applications are available on the CSHCN Services Program website at hhs.texas.gov/doing-business-hhs/provider-portals/health-servicesproviders/children-special-health-care-needs-services-program/family-support-services.
Mail completed enrollment applications to the following address:
CSHCN Services Program—Provider Enrollment
MC-1938
PO Box 149030
Austin, TX 78714–9947
Fax: 1-512-776-7238
Deliveries and overnight mail to the following address:
CSHCN Services Program—Provider Enrollment
MC-1938
Health and Human Services Commission-Moreton Building
1100 West 49th Street
Austin, TX 78756–3179
Fax: 1-800-441-5133
Additional information about the CSHCN Services Program is available online at www.hhs.texas.gov/doing-business-hhs/provider-portals/health-services-providers/children-special-health-care-needs-services-program.
1.3.2Regional Offices
Case management and client eligibility services are provided by a statewide network of regionally-based social service program consultants and include the following activities:
•Coordination of medical services
•Linkage to available resources
•Acting as a liaison among the client, family, and caregivers
•Management of institutional services, insurance carriers, and other services required for the improved well-being of the client and family
Refer to: “Appendix A: Acronyms and Initialisms Dictionary” for definitions of the abbreviated academic degrees listed in the following tables.
DSHS Health Service Region (HSR) 1 3407 Pony Express Way, Amarillo, TX 79118 | |
1L - Lubbock Regional Office Health Services Region 1 Telephone: 1-806-744-3577 or Fax: 1-806-783-6455 |
2A - Abilene Office Health Services Region 2 Telephone: 1-325-795-5847 Fax: 1-325-795-5894 |
3 - Regional Office (Arlington) Health Services Region 3 Telephone: 1-817-264-4634 or Fax: 1-817-264-4911 | |
Bonham Office PO Box 605 (mailing address) Telephone: 1-903-486-9258 Fax: 1-903-486-9286 | |
Granbury Office 214 North Travis Street Telephone: 1-817-579-2117 Fax: 1-817-578-3310 | |
Denton Office 3612 East McKinney Telephone: 1-940-320-8275 |
4/5N - Regional Office (Tyler) Health Service Region 4/5N Telephone: 1-903-533-5269 Toll free: 1-877-340-8842 Fax: 1-903-535-7593 | |
Athens Office 708 East Corsicana Telephone: 1-903-675-9107 Fax: 1-903-675-3622 | |
Carthage Office 1430 South Adams Telephone: 1-903-693-9322 Toll Free: 1-800-306-0568 Fax: 1-903-694-2316 | |
Gilmer Office 324 Yapaco Telephone: 1-903-843-3030 Fax: 1-903-843-4264 | |
Henderson Office 700 Zeid Blvd. Telephone: 1-903-655-6256 Toll Free: 1-800-306-0568 Fax: 1-903-655-0104 | |
Linden Office 213 Hwy 8 N (physical address) 123 Kaufman (mailing address) Telephone: 1-903-756-4807 Fax: 1-903-756-5146 | |
Longview Office 1750 North Eastman Road Telephone: 1-903-232-3289 Toll Free: 1-866-327-1364 Fax: 1-903-232-3278 | |
Marshall Office 4105 Victory Drive Telephone: 1-903-927-0218 Toll Free: 1-866-327-1364 Fax: 1-903-927-0290 | |
Mount Pleasant Office 1014 North Jefferson Telephone: 1-903-577-1929 Toll Free: 1-866-268-6465 Fax: 1-903-577-8957 | |
Palestine Office 320 E. Spring Street, Suite D Telephone: 1-903-661-6089 Fax: 1-903-729-7034 | |
Paris Office 1460 19th Street NW Telephone: 1-903-737-0236 Fax: 1-903-737-0220 | |
Sulphur Springs Office 1400 College, Suite 167 Telephone: 1-903-439-9331 Toll Free: 1-866-518-0601 Fax: 1-903-439-9335 | |
Texarkana Office 3101 Summerhill Road Telephone: 1-903-791-3229 Fax: 1-903-791-3230 |
Center Office 912 Nacogdoches Telephone: 1-936-598-1231 Fax: 1-936-591-0162 | |
Crockett Office 1034 South Fourth Street Fax: 1-936-544-0280 | |
Jasper Office Jasper-Newton County Public Health District Telephone: 1-409-384-6829, Ext. 231 Fax: 1-409-384-7861 | |
Kirbyville Office 314 North Herndon (physical location) Fax: 1-409-423-4027 | |
Livingston Office 410 East Church Street, Suite B Telephone: 1-936-328-8240, Ext. 232 Toll Free: 1-888-851-4748 Fax: 1-936-328-8249 | |
Lufkin Office 1210 South Chestnut Telephone: 1-936-633-3657 Toll Free: 1-877-340-8840 Fax: 1-936-633-3667 | |
Nacogdoches Office 2614 N.W. Stallings Drive Telephone: 1-936-569-4982 or Fax: 1-936-569-4989 |
6/5S - Regional Office (Houston) 5425 Polk Avenue, Suite 460 Telephone: 1-713-767-3111 Fax: 1-713-767-3125 | |
Beaumont Office 3105 Executive Blvd. Telephone: 1-409-730-1837 Fax: 1-409-730-1845 | |
Conroe Office 608 North Drive Loop 336 East Telephone: 1-936-760-4704, 1-936-760-4750, or 1-936-760-4705 Fax: 1-936-760-4707 |
7T - Temple Office Health Service Region 7 Telephone: 1-254-771-6791 or 1-800-789-2865 Fax: 1-254-750-9372 | |
7A - Austin Office Health Services Region 7 Telephone: 1-512-873-6308 Toll Free: 1-800-789-2865 Fax: 1-512-873-6345 | |
Bastrop Office 104 Loop 150 West, Suite 102 Telephone: 1-512-321-2465 Fax: 1-512-321-4861 | |
Bryan Office 3000 Villa Maria Fax: 1-979-731-0191 | |
Lockhart Office 1403F Blackjack Street (physical location) Telephone: 1-512-376-1078 Fax: 1-512-398-0022 | |
Navasota Office 425 N. Lasalle (physical address) Telephone: 1-936-825-7586 Fax: 1-936-825-0380 | |
San Saba Office 421 E. Wallace Telephone: 1-325-372-5188 or Fax: 1-325-372-3297 | |
Waco Office 801 Austin Avenue, Suite 820F Telephone: 1-254-750-9339 or 1-254-750-9248 Fax: 1-254-753-0879 |
8 - San Antonio Office Health Service Region 8 Telephone: 1-210-949-2142 or Fax: 1-210-949-2047 | |
Uvalde Office 112 Joe Carper Drive Phone: 1-830-591-4388 or 1-830-591-4384 Fax: 1-830-278-1831 | |
Eagle Pass Office 1593 Veterans Boulevard Telephone: 1-830-758-4252 Fax: 1-830-773-4688 | |
Victoria Office 2306 Leary Lane Telephone: 1-361-574-7421 Fax: 1-361-574-7396 |
9/10 - El Paso Office Health Services Region 9/10 Telephone: 1-915-834-7675 Fax: 1-915-834-7808 | |
Midland Office 2301 N Big Spring Street, Suite 300 Telephone: 1-432-683-9492 Fax: 1-432-684-3932 | |
San Angelo Office 622 South Oakes, Suite H Telephone: 1-325-659-7853 Fax: 1-915-655-6798 |
11H - Harlingen Office Health Service Region 11 Telephone: 1-956-423-0130 Fax: 1-956-444-3293 | |
Alice Office 408 N. Flournoy, Suite C Telephone: 1-361-660-2263 Fax: 1-361-668-4000 | |
11C - Corpus Christi Office Health Services Region 11 Telephone: 1-361-878-3450 Fax: 1-361-883-9942 | |
11L - Laredo Office 1500 Arkansas Avenue, Suite 3 Telephone: 1-956-794-6385 Fax: 1-956-729-8600 | |
11M - McAllen Office Health Services Region 11 Telephone: 1-956-971-1312 Fax: 1-956-971-1275 | |
Mercedes Office Health Services Region 11 Telephone: 1-956-825-5300 Fax: 1-956-825-5320 | |
Brownsville Office 1000 W. Price Road Telephone: 1-956-554-5500 Fax: 1-956-554-5581 | |
Rio Grande City Office 608 N. Garza Telephone: 1-956-487-5556 Fax: 1-956-487-8865 |