Appendix A: State, Federal, and TMHP Contact Information
A.1Texas Health and Human Services Commission (HHSC) and Texas Department of State Health Services (DSHS) Office Addresses
Use the following address for general inquiries or for any group that is not listed in the following table:
Texas Health and Human Services Commission
PO Box 13247
Austin, TX 78711-3247
Note:Remember to use the four-digit addition to the ZIP Code.
Use the following address for the HHSC Inspector General:
Texas Health and Human Services Commission
Office of Inspector General
PO Box 85200
Austin, TX 78708-5200
Note:Remember to use the four-digit addition to the ZIP Code.
For the following groups, use the corresponding address and include the group name on the second line of the address.
Address | Group Name |
|---|---|
HHSC | |
HHSC | |
HHSC Mail Code 1354 Austin, TX 78708-5200 | |
HHSC Medical & UR Appeals | |
HHSC | |
HHSC | |
DSHS | Children with Special Health Care Needs (CSHCN) Services Program (Mail Code 1938) Genetic Services (1918) Indigent Health Care (Mail Code 2831) Texas Health Steps (THSteps) (Mail Code 1938) Case Management for Children and Pregnant Women (Mail Code 1938) |
A.2HHSC Access and Eligibility Services (AES)
Region | Regional Director | Administrative Assistant | ||
|---|---|---|---|---|
01 | Beth Miller | Office: | 1-806-783-6637 | |
6302 Iola Avenue | FAX: | 1-806-783-6630 | 1-806-783-6632 | |
Lubbock, TX 79424 | Mail Code: 217-1 |
| ||
Amarillo: 1-806-356-3151 | Toll Free: | 211 |
| |
02/09 | Sandra McKinney | Office: | 1-325-795-5526 | |
4601 South First Street | FAX: | 1-325-795-5523 | 1-325-795-5522 | |
Abilene, TX 79604 | Mail Code: 001-1 |
| ||
PO Box 521 Abilene, TX 79604 | Toll Free: | 211 |
| |
03 | Tracy Hays | Office: | 1-972-337-6171 | |
801 South State Hwy 161 | FAX: | 1-972-337-6298 | 1-972-337-6166 | |
Grand Prairie, TX 75051 | Mail Code: 012-5 | |||
PO Box 532089 Grand Prairie, TX 75053-2089 | Toll Free: | 211 | ||
04 | Fay Booker | Office: | 1-903-509-5142 | |
302 East Rieck Road | FAX: | 1-903-509-5133 | 1-903-509-5125 | |
Tyler, TX 75703 | Mail Code: 313-5 |
| ||
| Toll Free: | 211 |
| |
05 | Stephanie Semien | Office: | 1-409-951-3425 | |
350 Pine Street, 9th Floor | FAX: | 1-409-951-3449 | 1-409-730-4027 | |
Beaumont, TX 77701 | Mail Code: 028-1 |
| ||
| Toll Free: | 211 |
| |
06 | Gracie Perez | Office: | 1-713-767-2417 | |
5425 Polk Street, Suite 230 | FAX: | 1-713-767-2323 | 1-713-767-3177 | |
Houston, TX 77023 | Mail Code: 178-7 |
| ||
PO Box 16017 | Toll Free: | 211 |
| |
07 | Sandra Dillett | Office: | 1-512-832-7617 | |
4616-1 West Howard Lane, Suite 120 | FAX: | 1-512-832-7665 | 1-512-832-7692 | |
Austin, TX 78728 | Mail Code: 016-1 | |||
Toll Free: | 211 | |||
08 | Teriann Lyons | Office: | 1-210-619-8226 | |
11307 Roszell | FAX: | 1-210-619-8293 | 1-210-619-8019 | |
San Antonio, TX 78217 | Mail Code: 279-4 | |||
PO Box 23990 | Toll Free: | 211 | ||
10 | Kate Hill | Office: | 1-915-834-7580 | |
401 East Franklin | FAX: | 1-915-834-7582 | 1-915-834-7581 | |
El Paso, TX 79901 | Mail Code: 111-1 | |||
PO Box 981017 | Toll Free: | 211 | ||
11 | Cynthia Pena | Office: | 1-956-316-8272 | |
2520 South Veterans Road | FAX: | 1-956-316-8175 | 1-956-316-8277 | |
Edinburg, TX 78539 | Mail Code: 108-1 | |||
PO Box 960 | Toll Free: | 211 | 1-956-316-8361 | |
ART & Customer Care Center | Debra Gault | Office: | 1-713-696-2380 | |
1457 E 40th St | FAX: | 1-956-316-8175 | 1-979-282-6519 | |
Houston, TX 77022 | Mail Code: 945-1 | |||
MEPD | Rachel Patton | Office: | 1-512-908-9431 | |
1601 Rutherford Lane | FAX: | 1-903-927-0280 | ||
Austin, TX 78754 | Mail Code: 227-1 | |||
For additional office information, visit the HHSC website at hhs.texas.gov.
Refer to: Subsection A.5, “DSHS Health Service Regions Map” in this section to identify the regional boundaries.
A.2.1Telephone Communication with HHSC and DSHS
Contact | Telephone Number |
|---|---|
Assessment Utilization Services (limited program) (Option 4) | 1-800-436-6184 |
HHSC Hearing Services for Children (HSC) (hearing aid, evaluations) | 1-800-925-9126 |
DSHS Emergency Medical Services Division | 1-512-834-6700 |
DSHS ImmTrac2 Help Desk | 1-800-348-9158 |
DSHS Immunization Branch | 1-800-252-9152 |
Medical Transportation Program (MTP) Hotline | 1-877-633-8747 |
THSteps/EPSDT Hotline | 1-877-847-8377 |
Medicaid Vendor Drug Program Pharmacy Provider Resolution Helpdesk (fee-for-service) | 1-800-435-4165 |
A.3Client Telephone Communication with HHSC
Clients can call the client toll-free number at 1-800-252-8263.
A.4Federal and State Telephone Numbers
Telephone Number | Department/Program |
|---|---|
1-800-CDC- INFO | AIDS Hotline (Nationwide, distributed by Centers for Disease Control and Prevention [CDC], Atlanta, Georgia) |
1-800-299-2437 | HIV/STD InfoLine |
1-800-255-1090 | Texas HIV Medication Program |
1-800-252-5400 | Child/Elder Abuse Intake (Department of Family and Protective Services [DFPS]) |
1-512-776-7420 | Vision and Hearing Screening Program (DSHS) |
1-512-834-6650, Ext. 2601 | Clinical Laboratory Improvement Amendments (CLIA) Certification Line |
1-800-458-9858 | Client Abuse Hotline for Long Term Care Services and Support— |
1-800-252-8263 | Client Inquiry Hotline (HHSC) (Medicaid questions from clients with |
1-512-776-7745 | THSteps Program (DSHS) |
1-888-963-7111 ext. 7318 or | THSteps Laboratory Services (DSHS) |
1-888-963-7111 ext. 7661 or | Laboratory Supply Orders (DSHS) |
1-888-963-7111 ext. 7578 or | Report of Laboratory Test Results (DSHS) |
1-512-776-7796 | HHSC Family Planning |
1-800-436-6184 | Fraud or Abuse of Provider Services (HHSC Office of Inspector General) |
1-800-436-6184 | Fraud or Abuse/Long Term Care Services and Support—Nursing Facilities/HHSC |
1-800-436-6184 | Fraud or Abuse/Client/HHSC Office of the Inspector General |
1-800-792-1109 | Goal-Directed Therapy |
1-512-438-3169 | Hospice Program (HHSC Policy Development division) |
1-800-252-9152 | Immunization Branch (DSHS) |
1-800-925-9126 | Medically Needy Spend Down Unit |
1-800-MEDICARE | Medicare/Social Security Administration |
1-800- 925-9126 | Newborn Screening (DSHS) |
1-800-925-9126 | HHSC Hearing Services for Children (HSC) |
1-877-787-8999 | HHS Office of the Ombudsman (for information about ECI or to refer a child.) |
1-800-436-6184 | Recipient Utilization Control Unit (HHSC) |
1-512-776-7796 | Breast and Cervical Cancer Services (DSHS) |
1-713-526-2559 | Snellen Letter (Tumbling E Wall Chart) |
1-800-435-4165 | Medicaid Vendor Drug Program (HHSC) (fee-for-service) |
1-877-728-3927 | Medicaid Vendor Drugs Prior Authorization Center (fee-for-service) |
1-866-993-9972 | Healthy Texas Women (HTW) program Eligibility |
1-512-776-7796 | Cervical Cancer Screening |
A.5DSHS Health Service Regions Map
A.6DSHS Health Service Region Contacts
Health Service Region 1 | Health Service Regions 2 & 3 |
|---|---|
DSHS/PHR 1 | DSHS/PHR 2 & 3 |
Regional Medical Director | Regional Medical Director |
Deputy Regional Director | Deputy Regional Director (acting) |
Manager of Social Work Services and Case Management | Manager of Social Work Services and Case Management |
Communicable Disease Manager | Director of Clinic Operations |
Immunization Program Manager | Immunization Program Manager |
Tuberculosis Team Leader | Communicable Disease Program Manager |
THSteps Operations Lead 6302 Iola Ave | Tuberculosis Team Leader |
Emergency Preparedness | |
THSteps Operations Lead | |
HIV/STD Program Manager |
Health Service Regions 4 & 5 (North) | Health Service Regions 6 & 5 (South) |
|---|---|
DSHS/PHR 4 & 5 North | DSHS 6 & 5 South |
Regional Medical Director | Regional Medical Director (Acting) |
Deputy Regional Director | Deputy Regional Director |
Manager of Social Work Services and Case Management | Manager of Social Work Services and Case Management |
Director of Nursing | Director of Nursing |
Immunization Program Manager | Immunization Program Manager |
HIV/STD Program Manager | HIV/STD Program Manager |
Tuberculosis Program Manager | Tuberculosis Program Manager |
THSteps Operations Lead | THSteps Operations Lead |
* Health Service Region 7 | Health Service Region 8 |
|---|---|
DSHS/PHR 7 | DSHS/PHR 8 |
Regional Medical Director | Regional Medical Director |
Deputy Regional Director | Deputy Regional Director |
Manager of Social Work Services and Case Management | Manager of Social Work Services and Case Management |
Director of Nursing | Director of Nursing |
Immunization Program Manager | Immunization Program Manager |
HIV/STD Program Manager | Communicable Disease Program Manager |
Tuberculosis Program Manager/Nurse Consultant | HIV/STD Program Manager |
THSteps Operations Co-Leads | THSteps Operations Lead |
THSteps Operations Co-Leads |
Health Service Regions 9 & 10 | Health Service Region 11 |
|---|---|
DSHS/PHR 9 & 10 | DSHS/PHR 11 |
Regional Medical Director | Regional Medical Director |
Deputy Regional Director | Deputy Regional Director |
Manager of Social Work Services and Case Management | Manager of Social Work Services and Case Management |
Director of Nursing | Director of Nursing |
Immunization Program Manager | Immunization Program Manager |
HIV/STD Program Manager | HIV/STD Program Manager |
Communicable Disease Manager | Tuberculosis Program Manager |
THSteps Operations Lead | THSteps Operations Lead |
A.7State Participating Local Health Departments and Public Health Districts
Information for local health departments and public health districts can be found on the Texas Department of State Health Services website at: https://www.dshs.texas.gov/regional-local-health-operations/public-health-regions/texas-local-public-health
A.8Texas Health and Human Services Commission Blind Children’s Vocational Discovery and Development Program (BCVDDP)
HHSC, BCVDDP | |
|---|---|
Abilene PO BOX 521 | Irving |
Amarillo | Laredo |
Austin | Lubbock |
Beaumont | McAllen |
Bryan College Station | Odessa |
Corpus Christi | San Angelo |
Dallas | San Antonio |
El Paso | Tyler |
Fort Worth | Victoria |
Harlingen | Waco |
Houston | Wichita Falls |
Houston-Southeast | |
A.9HHSC Open Records Requests
Providers who would like to make open records requests should visit the Open Records page of the HHSC website. For general inquiries, such as claim status inquiries, eligibility verification, and prior authorization requests, refer to subsection A.10, “TMHP Telephone and Fax Communication” in this section for contact information.
A.10TMHP Telephone and Fax Communication
Contact | PA Request Telephone Number | General Inquiry Telephone Number | Fax Number |
|---|---|---|---|
General Information | |||
TMHP Contact Center | N/A | 1-800-925-9126 or 1-512-335-5986 | |
Automated Inquiry System (AIS) | N/A | 1-800-925-9126 or 1-512-335-5986 | |
Provider Enrollment | N/A | TMHP Contact Center | 1-512-514-4214 |
Telephone appeals | N/A | 1-800-745-4452 | |
TMHP Electronic Data Interchange (EDI) Help Desk | N/A | 1-888-863-3638 | 1-512-514-4228 1-512-514-4230 |
Program and Prior Authorization Information | |||
Ambulance (Medicaid and CSHCN Services Program) | 1-800-540-0694 | TMHP Contact Center | 1-512-514-4205 Prior Authorization Only |
Children with Special Health Care Needs (CSHCN) Services Program | N/A | 1-800-568-2413 | 1-512-514-4222 Prior Authorization Only |
Comprehensive Care Program (CCP) (for CCP prior authorization status and general CCP and Home Health Services information) | N/A | 1-800-846-7470 | 1-512-514-4212 Prior Authorization Only |
CCP personal care services (PCS) | N/A | 1-888-648-1517 | N/A |
Inpatient Psychiatric Services | N/A | 1-800-213-8877 | 1-512-514-4211 Prior Authorization Only |
Home Health Services | Requests for new prior authorization or extensions cannot be made over the telephone. | TMHP Contact Center | 1-512-514-4209 Prior Authorization Only |
Obstetric ultrasound | 1-800-302-6167 | TMHP Contact Center | 1-512-302-5039 Prior Authorization Only |
Special Medical Prior Authorization (SMPA) | N/A | TMHP Contact Center | 1-512-514-4213) Prior Authorization Only |
Texas Health Steps (THSteps) dental inquiries | N/A | 1-800-568-2460 | N/A |
THSteps medical inquiries | N/A | 1-800-757-5691 | N/A |
Family Planning (tubal ligation and vasectomy consent forms) | N/A | TMHP Contact Center | 1-512-514-4229 |
Hysterectomy acknowledgment statements | N/A | TMHP Contact Center | 1-512-514-4218 |
Other Program and Reimbursement Information | |||
Health Insurance Premium Payment (HIPP) | N/A | 1-800-440-0493 | |
Long Term Care (LTC) operations | N/A | 1-800-626-4117 | |
LTC—Nursing Facilities | N/A | 1-800-727-5436 | |
Medicaid Audit/Cost Reports | N/A | 1-512-506-6117 | 1-512-506-7811 |
Third Party Liability (TPL) (Option 2) | N/A | 1-800-846-7307 | 1-512-514-4225 |
Tort (Option 3) | N/A | 1-800-846-7307 | 1-512-514-4225 |
A.11Written Communication With TMHP
All CMS-1500 forms (excluding ambulance, radiology/laboratory, immunization services, rural health, and mental health rehabilitation) sent to TMHP for the first time, as well as claims being resubmitted because they were initially denied as incomplete claims, must be sent to the following address:
Texas Medicaid & Healthcare Partnership
Claims
PO Box 200555
Austin, TX 78720-0555
The post office box addresses must be used for the specific items listed in the following table:
Correspondence | Address |
|---|---|
Appeals/adjustments of claims (except zero paid/zero allowed on Remittance & Status [R&S] Reports) | Texas Medicaid & Healthcare Partnership |
All first-time claims | Texas Medicaid & Healthcare Partnership |
Ambulance Authorization (includes out-of-state transfers) | Texas Medicaid & Healthcare Partnership |
CCP requests (prior authorization and appeals) | Texas Medicaid & Healthcare Partnership |
CSHCN Services Program claims | Texas Medicaid & Healthcare Partnership |
Home Health Services prior authorizations | Texas Medicaid & Healthcare Partnership |
Medicaid audit correspondence | Texas Medicaid & Healthcare Partnership |
Medically Needy Clearinghouse (MNC) or Spend Down Unit correspondence | Texas Medicaid & Healthcare Partnership |
Provider Enrollment correspondence | Texas Medicaid & Healthcare Partnership |
Other provider correspondence | Texas Medicaid & Healthcare Partnership |
Send all other written communication to TMHP | Texas Medicaid & Healthcare Partnership |
TMHP Fee-for-Service and ICF-IID Dental prior authorization requests | Texas Medicaid & Healthcare Partnership |
TPL/Tort correspondence | Texas Medicaid & Healthcare Partnership |
The TMHP website at www.tmhp.com is a valuable resource that provides:
•Provider education information and training.
•Publications, such as bulletins, banner messages, and provider manuals.
•A TMHP News section with announcements of program changes and other important information.
•Real-time and static fee schedules.
•Online provider enrollment.
•Complete instructions for setting up a Provider Administrator account and the use of online claims status inquiries (CSI), eligibility verification, and Electronic Remittance and Status (ER&S) Reports.
• A chatbot for frequently asked questions and a live chat to speak with an agent.
Additional advanced features are available for those providers who create an account. All enrolled providers are eligible for this free account. Once an account is activated, providers will have access to:
•Texas Medicaid enrollment information.
•CSIs.
•Eligibility verification.
•ER&S Report download option.
•Claims submission.
•Claims appeals.
•Online provider lookup.
•Online fee lookup (OFL) to obtain real-time fee information for an individual or a range of procedure codes. Benefits and limitations for certain services and history up to 2-years is also available.
•Payment amounts search, view, and print capabilities.
•Notification of an invalid address on file for a provider’s National Provider Identifier (NPI).
•Notification of pending payments because of inaccurate or incomplete provider information.
•Manage hospital admission and discharge information on clients residing in an institution for mental diseases (IMD)
Important:Natural disasters, such as floods or hurricanes, can impact the delivery of health care to Texas Medicaid clients. When disaster strikes, providers should monitor the TMHP website for special instructions.
New services are always being added to the website. Please visit www.tmhp.com for the latest information on TMHP online services.
The TMHP Contact Center is available from 7 a.m. to 7 p.m., Central Time, Monday through Friday.
The TMHP Contact Center assists with questions such as:
•Provider enrollment procedures
•Claims filing procedures
•Policy information
The TMHP Contact Center is available to assist providers and clients. Please review the telephone and fax communication guides in this section for a list of contact telephone and fax numbers.
Provider calls, including those that were previously made to the Provider Relations territory representatives, are now handled first by the Contact Center. The Contact Center is well equipped to handle most inquiries about benefits and claims.
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.
Resolution of more complex issues that are referred to Provider Relations for further analysis can take up to 30 days from the date of the referral. For these issues, Provider Relations will contact the provider by telephone or e-mail when the issue has been resolved.
For questions or information about Medicaid eligibility, clients are referred to their caseworker or the local HHSC office.
A.12.3Automated Inquiry System (AIS)
AIS provides the following information and services through the use of a touch-tone telephone:
•Claim status
•Patient eligibility
•Benefit limitations
Eligibility and claim status information is available on AIS 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 from 7 a.m. until 7 p.m., Central Time, Monday through Friday. AIS offers 15 transactions per call.
A.12.4TMHP Provider Relations
The TMHP Provider Relations Department comprises a staff of Austin- and field-based provider relations representatives whose goal is to serve the health-care community by furnishing a variety of services and activities designed to inform and educate health-care providers about Texas Medicaid activities and claim submission procedures.
Provider Relations activities include the following:
•Provider education through planned events. Provider Relations representatives conduct a planned program of educational workshops, in-services, webinars, computer-based training (CBT), and other training sessions designed to keep all actively-enrolled providers informed of the latest policies, claim processing procedures, and federal and state regulations affecting Texas Medicaid. Details of all available provider training can be found in the Provider Education section of the TMHP website at www.tmhp.com.
•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 TMHP 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 Texas Medicaid, the Provider Relations Department maintains a work relationship with these organizations. Also, the Provider Relations Department participates in several events sponsored by Texas health-care associations, such as conventions and conferences.
Call the TMHP Contact Center at 1-800-925-9126 for assistance.
A.12.5Reporting a Complaint to TMHP
Providers can report complaints by calling the TMHP Contact Center at 1-800-925-9126 or by submitting a written complaint to:
TMHP
Complaints Resolution Department
PO Box 2014270
Austin, TX 778720-4270
A complaint is defined as any dissatisfaction concerning any aspect of Texas Medicaid. The term “complaint” does not include a misunderstanding or a problem with misinformation that is resolved promptly by clearing up the misunderstanding or supplying the appropriate information to the provider’s satisfaction.
Providers should submit the following information when reporting the complaint:
•Point of contact name and phone number or email address
•Provider name
•Provider NPI, if available
•Description of the complaint situation
•Client name
•Client PCN
•Date of service
A.12.6TMHP Electronic Data Interchange (EDI) Help Desk
The TMHP EDI Help Desk assists Medicaid providers with EDI transactions. The TMHP EDI Help Desk is available at 1-888-863-3638 from 7 a.m. to 7 p.m., Central Time, Monday through Friday.
TMHP EDI Help Desk activities and responsibilities include, but are not limited to, the following:
•Enrolling providers for electronic billing
•Qualifying vendors for TMHP EDI production through testing
•Diagnosing claim transmission problems through research
•Consulting with provider billing personnel, billing services, and software vendors regarding TMHP EDI
TMHP EDI Help Desk staff assists with questions about TMHP EDI, TexMedConnect, and electronic transmissions at 1-888-863-3638.
Providers who employ hardware or software vendors should contact those vendors for the resolution of technical problems.