Texas medicaid provider manual 2021 2, Provider Handbooks) for an overview of family Call to action: Effective July 1, 2021, The Texas Medicaid and Healthcare Partnership (TMHP) updated the Texas Medicaid Provider Procedures Manual, Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook, section 4. To learn more, please call: Provider Services (follow prompts) 1-800-248-7767 (Bexar) or . 2, Provider Handbooks) for an overview of family planning Texas Medicaid Provider Procedures Manual The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Note: In the event of a conflict between the manual and the provider's contract, the contract will govern. 8 3 Services, Benefits, Limitations, and Prior Authorization. TELECOMMUNICATION SERVICES HANDBOOK MARCH 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 2 OUTPATIENT DRUG SERVICES HANDBOOK APRIL 2021 7 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 1-800-306-8612 (Tarrant) 1 Aetna Better Health® of Texas Medicaid (STAR), STAR Kids and CHIP/CHIP Perinate Molina Healthcare of Texas Medicaid, CHIP, MMP Provider Manual Any reference to Molina Healthcare Members means Molina Healthcare Medicaid, CHIP or MMP Members. CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. MEDICAL TRANSPORTATION PROGRAM HANDBOOK FEBRUARY 2021 3 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 2, Provider Handbooks) for an overview of family planning The Texas Medicaid & Healthcare Partnership (TMHP) Handbooks May 2021 Texas Medicaid Provider Procedures Manual Medical Transportation Program Handbook. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including Texas Medicaid Provider Procedures Manual Medicaid Managed Care Handbook. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including medical, dental, and children’s February 2021 Texas Medicaid Provider Procedures Manual Health and Human Services Family Planning Program Services Handbook. 2 FEBRUARY 2021 CHILDREN’S Texas Medicaid Provider Procedures Manual Behavioral Health and BEHAVIORAL HEALTH AND CASE MANAGEMENT SERVICES HANDBOOK MAY 2021 6 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 2, Provider Handbooks) for an overview of family Texas Medicaid Provider Procedures Manual Vision and Hearing Services Handbook. 4, 87th Legislature, Regular Session, 2021 • Temporary teleservices website which includes related notices and links to rules • Texas Medicaid Provider Procedures Manual • Uniform Managed Care Manual, Chapter 16. Texas Medicaid and Healthcare Partnership (TMHP) – The Texas Medicaid Claims administrator. it is a violation of Texas Medicaid rules when a provider fails to provide healthcare services or items to Medicaid clients in The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. 2 OUTPATIENT DRUG SERVICES HANDBOOK MARCH 2021 7 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 2 manual. Texas Medicaid Provider Procedures Texas Medicaid Provider Procedures Manual January 2021 Provider Handbooks Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership To participate in the Texas Medicaid and/or Children’s Health Insurance Program (CHIP) program(s), the dentist must be credentialed, must execute a Provider Agreement, and must Provider Services | (855) 322-4080 | MolinaHealthcare. All SHARS policies must be consistent with the Texa s state plan and the following Texas Administrative Code rules: • 1 TAC §354. 2, Provider Handbooks) for information about CNM After the provider has exhausted all aspects of the appeals process for the entire claim, the provider may submit a second-level appeal to HHSC. Provider Handbooks March 2021 Texas Medicaid Provider Procedures Manual Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook • Provider information (excluding Medicare crossovers). Provider Handbooks February 2021 Texas Medicaid Provider Procedures Manual Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook Providers of SHARS services must meet Texas Medicaid provider qualifications for each service according to the Texas Medicaid state plan and the Texas Medicaid Provider Procedures Manual (TMPPM). Texas Medicaid Provider Procedures Manual Certified Respiratory Care Practitioner (CRCP) Services Handbook. 1659. 1 Clinical Laboratory Improvement Amendments (CLIA) Texas Medicaid Provider Procedures Manual School Health and Related Services (SHARS) Handbook. 1617(6)(A). 1342 Texas Medicaid Provider Procedures Manual Clinics and Other Outpatient Facility Services Handbook. 00 4/1/1995 $0. 1, “Provider Enrollment” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. • Home Health Nursing and Private Duty Nursing Services Handbook General program policies and procedures are included in the Healthy Texas Women (HTW) Handbook, which is included in the Texas Medicaid Provider Procedures Manual (TMPPM). Providers of SHARS services must meet Texas Medicaid provider qualifications for each service according to the Texas Medicaid state plan and the Texas Medicaid Provider Procedures Manual (TMPPM). 3. 3, Texas Medicaid Provider Procedures Manual Clinics and Other Outpatient Facility Services Handbook. Provider Handbooks April 2021 Texas Medicaid Provider Procedures Manual Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) February 2021 Texas Medicaid Provider Procedures Manual Children’s Services Handbook. • Home Health Nursing and Private Duty Nursing Services Handbook The current version of the manual always appears prominently on the Texas Medicaid Provider Proce-dures Manual web page. 1. • Claim corrections. Texas Medicaid Provider Procedures Manual Vision and Hearing Services Handbook. requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371. 2, Provider Handbooks) for an overview of family The current version of the manual always appears prominently on the Texas Medicaid Provider Proce-dures Manual web page. 1) A first-level appeal is a provider’s initial standard administrative or medical appeal of a claim that has been denied or adjusted by TMHP. CHIP: Harris, Jefferson, and Nueces. 1, “Services, Benefits, Limitations, and Prior Authorization,” and Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9. under contract with the Texas Health and Human Services Commission. It contains information about Texas Medicaid fee-for-service Provider Procedures Manual The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Texas Medicaid Provider Procedures Manual. 1342 Blue Cross and Blue Shield of Texas Medicaid Provider Manual For Physicians, other Professional Providers, Facilities, Ancillary Providers and LTSS Providers November 2022 STAR/CHIP: Travis Service Area Provider Customer Service 1-877-560-8055 STAR Kids: Medicaid Rural Service Area (MRSA) Central /Travis Service Area The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Day February 15, 2021 Presidents Day May 31, 2021 Memorial Day July 4, 2021 Independence Day September 6, 2021 Labor Day October 11, 2021* Columbus Day November 11, 2021 Veterans Day November 25, 2021 PRELIMINARY INFORMATION JANUARY 2021 3 ALL RIGHTS RESERVED. Refer to: Subsection 3. 2 CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. Providers can access the most current Provider Manual at . STAR: Harris, Hidalgo, Jefferson, and Nueces • Adults who qualify for Texas Medicaid due to chronic conditions and financial eligibility • Children and young adults through age 20 with disabilities, PROVIDER MANUAL Molina Healthcare of Texas, Inc. The current version of the manual always appears prominently on the Texas Medicaid Provider Proce-dures Manual web page. 2 OUTPATIENT DRUG SERVICES HANDBOOK FEBRUARY 2021 7 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. CLINICS AND OTHER OUTPATIENT FACILITY SERVICES HANDBOOK MARCH 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. net. • Implement a process to have designated health care The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Texas Medicaid Provider Procedures Manual Home Health Nursing and Private Duty Nursing Services Handbook. UnitedHealthcare Community Plan of Texas Physician, Health Care Professional, Facility and Ancillary Care Provider Manuals apply to the following plans: STAR+PLUS and the UnitedHealthcare Connected™ (Medicare-Medicaid Plan) Care Provider Manual; UnitedHealthcare Community Plan of Texas Nursing Facility Care Provider Manual; Virginia Provider Manual: Texas Medicaid and CHIP MCNA_TX-P_PM[1. SERVICES HANDBOOK FEBRUARY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. CLINICS AND OTHER OUTPATIENT FACILITY SERVICES HANDBOOK APRIL 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. Texas Medicaid Provider Procedures Manual Outpatient Drug Services Handbook. 16] Page 1 PROVIDER MANUAL For Texas Medicaid and CHIP Members Last Updated: August 2021 MCNA Dental 200 West Cypress Creek Road, Suite 500 Fort Lauderdale, Florida 33309 Contact the Provider Hotline at 1-855-PRO-MCNA (1-855-776-6262) or visit us online at www. 2, “Developmental Surveillance or Screening,” and subsection 5. 2 Overview of Medicaid Managed Care Texas Medicaid, which is administered by the Texa s Health and Human Services Commission (HHSC), operates Medicaid managed care under the authority of federal waivers and state plan amendments that The TMPPM archives contain the complete Texas Medicaid Provider Procedures Manual that was published each month of the specified year. INPATIENT AND OUTPATIENT HOSPITAL SERVICES HANDBOOK APRIL 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. For detailed benefits and limitations, providers should refer to the current year’s Texas Medicaid Provider Procedures Manual and relevant issues of the Texas Medicaid Bulletin. In addition to compliance with all requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371. Refer to: “Section 1: Provider Enrollment and Responsibilities” (Vol. 2 SEPTEMBER 2021 MEDICAID MANAGED CARE HANDBOOK Table of Contents. The name and address of the provider are required for the facility and outside laboratory. it is a violation of Texas Medicaid rules when a provider fails to provide health-care services or items to Medicaid CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. it is a violation of Texas Medicaid rules when a provider fails to provide healthcare services or items to Medicaid clients in accordance with Amerigroup retains the right to add to, delete from and otherwise modify this provider manual. SERVICES HANDBOOK MAY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. HEALTHY TEXAS WOMEN PROGRAM HANDBOOK JANUARY 2023 4 CPT ONLY - COPYRIGHT 2022 AMERICAN MEDICAL ASSOCIATION. HHSC Family Planning Program Policy Manual for sp ecific eligibility, services, and policy information HHSC Healthy Texas Women Cost Reimbursement Manual, Effective XX/2021 6 Service – Any client encounter at a facility that results in the client having a medical or health-related need met. In the event any discrepancies arise between this manual and a provider agreement, with respect to FirstCare policies and procedures, the language in the more current of the two documents will prevail. 1341 & §354. 1342 Texas Medicaid Provider Procedures Manual Home Health Nursing and Private Duty Nursing Services Handbook. Refer to: Subsection 1. 2 * Pharmacy Enrollment . com The Provider Manual is customarily updated annually but may be updated more frequently as policies or regulatory requirements Call to action: Effective July 1, 2021, The Texas Medicaid and Healthcare Partnership (TMHP) updated the Texas Medicaid Provider Procedures Manual, Gynecological, Provider Manual. gov. 2 CPT ONLY - COPYRIGHT 2024 AMERICAN MEDICAL ASSOCIATION. MHTPROVMN042021 2021 (published in the Federal Register on September 14, 2021, 86 FR 50985). 1 million in 2019 to 7. Provider Handbooks May 2021 Texas Medicaid Provider Procedures Manual Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide health- Texas Medicaid Provider Procedures Manual Inpatient and Outpatient Hospital Services Handbook. 2, Provider Handbooks) for an overview of family The Texas Medicaid & Healthcare Partnership (TMHP) February 2022 Texas Medicaid Provider Procedures Manual Children’s Services Handbook. In addition to required compliance with all requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide healthcare services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Adminis- trative Code (TAC) §371. All SHARS policies must be consistent with the Texa s state plan and the following Texas Administrative Code rules: • 1 TAC § 354. 0000 $0. The Texas Medicaid Provider Procedures Manual is updated monthly on the TMHP website at www. Only the following holidays extend the deadlines in 2020 and 2021: Date Holiday January 1, 2021 New Year’s Day January 18, 2021 Martin Luther King, Jr. B. HOME HEALTH NURSING AND PRIVATE DUTY NURSING SERVICES HANDBOOK MAY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. Users can access the archives through links on the Texas Medicaid Provider Procedures Manual web page. 2 FEBRUARY 2022 COPYRIGHT CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. The manual is available in portable document format (PDF) as a complete book and as individual CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. Molina Healthcare of Texas Medicaid, CHIP, MMP Provider Manual Any reference to Molina Healthcare Members means Molina Healthcare Medicaid, CHIP or MMP Members. com to include revisions to policies and procedures that went into effect in the prior month. Member for 8 years 5 months Submitted by rarefyev on Tue, 08/31/2021 - 09:04. Molina Provider Manual. 12 . An HTW provider’s agency may be contracted with HHSC to receive additional Texas Medicaid Provider Procedures Manual The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid . VISION AND HEARING SERVICES HANDBOOK MARCH 2021 6 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. A primary therapist must be designated and authorized to bill for co-treatment. The file(s) below are in PDF format ( ) Provider Manual – Medicaid, CHIP & Molina Dual Options STAR+PLUS MMP Provider Manual-Nursing Facility-STAR+PLUS Texas Medicaid Provider Procedures Manual Radiology and Laboratory Services Handbook. MolinaHealthcare. Subject to the specifications, conditions, limitations, requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide health-care services or items to Medicaid eligible persons in accor-dance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371. 2 CPT ONLY it is a violation of Texas Medicaid rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with AMBULANCE SERVICES HANDBOOK JANUARY 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide healthcare services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371. HHSC Family Planning Program Policy Manual for sp ecific eligibility, services, and policy information Provider Handbooks February 2021 Texas Medicaid Provider Procedures Manual Healthy Texas Women Program Handbook. Provider Handbooks March 2021 Texas Medicaid Provider Procedures Manual Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook Providers are encouraged to review the current Texas Medicaid Provider Procedures Manual for information about provider responsibilities, claims filing procedures, filing deadlines, benefits and limitations, F00168 Page 3 of 20 EThective 01/01/2021 Enrollment Requirements Affordable Care Act In compliance with the Affordable Care Act of Texas Medicaid Provider Procedures Manual Certified Respiratory Care Practitioner (CRCP) Services Handbook. RADIOLOGY AND LABORATORY SERVICES HANDBOOK MARCH 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 1, “Family Planning Overview” in the Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook (Vol. Provider Handbooks September 2021 Texas Medicaid Provider Procedures Manual Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook Texas Medicaid Provider Procedures Manual Medical Transportation Program Handbook. HEALTHY TEXAS WOMEN PROGRAM HANDBOOK JULY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. Texas Medicaid Provider Procedures Manual Medicaid Managed Care Handbook. 1, General Information) for more information about enrollment procedures. 1 Clinical Laboratory Improvement Amendments (CLIA) Your Provider Manual includes detailed information about Texas Medicaid and CHIP, including covered services, submission requirements for claims and prior authorizations, dental guidelines, provider responsibilities, and contact information. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including medical, dental, and children’s 2021 Provider Manual STAR Plan CFHP_1359GOV_0221 star Provider services Provider services 210-227-2347 toll Free 1-800-434-2347 cfhp. HHSC contracts with TMHP to process claims for providers. 11. The 2021 ICD updates for Texas Medicaid are included in the ICD tables in the “All Code Changes” section of this bulletin beginning on page . We ensure that members have timely access to the services they need, and we work hard to encourage provider Texas Medicaid Provider Procedures Manual Telecommunication Services Handbook. requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide health-care services or items to Medicaid eligible persons in accor-dance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371. 2 APRIL 2022 OUTPATIENT DRUG SERVICES HANDBOOK Table of Contents Texas Medicaid Provider Procedures Manual School Health and Related Services (SHARS) Handbook. To ensure that we continue to deliver quality, cost-effective services, Texas Medicaid and CHIP is focused on several main priorities. MEDICAL TRANSPORTATION PROGRAM HANDBOOK MARCH 2021 3 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 1 Texas Medicaid Provider Procedures Manual Clinics and Other Outpatient Facility Services Handbook. It contains information about PRELIMINARY INFORMATION JUNE 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 2. October 2021 Texas Medicaid Provider Procedures Manual The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. 2 MARCH 2021 CHILDREN’S CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including medical, dental, and children’s Welcome: Texas Medicaid Provider Procedures Manual This manual is a comprehensive guide for Texas Medicaid providers. HEALTHY TEXAS WOMEN PROGRAM HANDBOOK MARCH 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. ) • Beginning with dates of service January 1, 2022 and after, all pre-COVID prior authorization timeframe and submission requirements will resume as outlined in the Texas Medicaid Provider Procedures Manual (TMPPM) and MCO policies. SERVICES E0350 0 20 Years 0. 1 * About the Vendor Drug Program . TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 8 2 Enrollment . Provider Handbooks April 2021 Texas Medicaid Provider Procedures Manual Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook Texas Medicaid Provider Procedures Manual Inpatient and Outpatient Hospital Services Handbook. INPATIENT AND OUTPATIENT HOSPITAL SERVICES HANDBOOK MARCH 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 2 AUGUST 2021 OUTPATIENT DRUG SERVICES HANDBOOK Table of Contents 1 General Information . One option is Adobe ® Reader ® which has a built-in reader. RADIOLOGY AND LABORATORY SERVICES HANDBOOK MAY 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 2 AUGUST 2022 MEDICAID MANAGED CARE HANDBOOK COVID-19 Updates (cont. It contains information about PRELIMINARY INFORMATION JANUARY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. Use the links on the left to The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Provider Handbooks May 2021 Texas Medicaid Provider Procedures Manual Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. (Molina Healthcare or Molina) Molina Marketplace . Texas Medicaid Provider Procedures Manual The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. The state of Texas • Maintain complete medical records that meet applicable Texas Medicaid Provider Procedure Manual requirements. The 2021 ICD deletions and replacements are effective October 1, 2021, for dates of service on or after October 1, 2021, for Texas Medicaid . The Provider, a subcontractor, shall comply with all guidance, Texas Medicaid Provider Procedures Manual The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. 7 1. com Atascosa • Bandera • Bexar • Comal • Guadalupe • Kendall • Medina • Wilson Texas Medicaid Provider Procedures Manual (TMPPM) −H. Providers will be notified of upcoming changes in articles published on this website. Providers may refer to the information on the STAR program, please refer to the current Texas Medicaid Provider Procedures Manual. 1 APRIL 2021 SECTION 1: PROVIDER ENROLLMENT AND To be eligible for Texas Medicaid reimbursement, a provider of health-care services (including an out-of-state provider) must: • Meet all applicable eligibility criteria. The Provider, a subcontractor, shall comply with all guidance, This manual will provide you with information about Molina and will describe how we will work together as you care for your patients' health care needs. HOME HEALTH NURSING AND PRIVATE DUTY NURSING SERVICES HANDBOOK MARCH 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL Provider manuals are the primary source of information for providers about Texas state health care programs. CLINICS AND OTHER OUTPATIENT FACILITY SERVICES HANDBOOK MAY 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. Provider Handbooks February 2021 Texas Medicaid Provider Procedures Manual Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. MEDICAL TRANSPORTATION PROGRAM HANDBOOK MAY 2021 3 CPT ONLY - The Texas Medicaid & Healthcare Partnership (TMHP) March 2021 Texas Medicaid Provider Procedures Manual Children’s Services Handbook. HOME HEALTH NURSING AND PRIVATE DUTY NURSING SERVICES HANDBOOK FEBRUARY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL June 1, 2021 – Effective for dates of service on or after June 1, Providers may refer to the current “Texas Medicaid Provider Procedures Manual, Children’s Services Handbook,” subsection 5. . The Provider Manual is customarily updated annually but may be updated more frequently as policies or regulatory requirements change. 2 Nonimplantable Hearing Aid Devices and Related Services Aetna Better Health® of Texas . adobe. The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. www. To view this file, you may need to install a PDF reader program. Provider Handbooks May 2021 Texas Medicaid Provider Procedures Manual Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. Providers may correct the: January 2021 Texas Medicaid Provider Procedures Manual Health and Human Services Family Planning Program Services Handbook. 00 5 6 9/1/2021 CCP PROVIDER 9 OTHER MEDICAL ITEMS OR SERVICES E0352 0 20 The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. This appeal is submitted by the provider directly to TMHP BCBSTX Provider Manuals are reference tools for providers. This appeal is submitted by the provider directly to TMHP Provider Handbooks August 2022 Texas Medicaid Provider Procedures Manual Medicaid Managed Care Handbook. MCNATX. Please note: Material in this provider manual is subject HEALTHY TEXAS WOMEN PROGRAM HANDBOOK DECEMBER 2022 4 CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. Subject to the specifications, conditions, limitations, patient’s health. 2 JUNE 2022 CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. The manual is available in Welcome: Texas Medicaid Provider Procedures Manual This manual is a comprehensive guide for Texas Medicaid providers. Volumes 1 & 2. Sections and subsection headings for revised portions of the manual are marked in red, preceded by an asterisk, and visible in the table of contents of each chapter emergency visits, which are listed in the Texas Medicaid Provider Procedures Manual and other updates on the claims administrator's website, HHSC will reimburse: TN: 21-0048 Approval Date: Supersedes TN: 15-0026 Effective Date: 09/01/2021 12/14/2021 HEALTHY TEXAS WOMEN PROGRAM HANDBOOK SEPTEMBER 2022 4 CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. 2 Nonimplantable Hearing Aid Devices and Related Services Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP ; Effective July 15, 2021 through December 31 Texas Medicaid Preferred Drug List Updates ; Effective STAR+PLUS, STAR Health and STAR Kids (Medicaid/CHIP) Provider Manual Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. 3 The current version of the manual always appears prominently on the Texas Medicaid Provider Proce-dures Manual web page. Contracted providers must acknowledge this provider manual and any other written materials provided by Amerigroup as proprietary and confidential. Provider Handbooks January 2021 Texas Medicaid Provider Procedures Manual Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook Texas Medicaid Provider Procedures Manual Medicaid Managed Care Handbook. The Texas Medicaid and CSHCN Services Program provider manuals are regularly updated to reflect the most recent policy and procedure changes. 7. tmhp. The secondary therapist will Texas Medicaid Provider Procedures Manual Radiology and Laboratory Services Handbook. Texas Medicaid Provider Procedures Manual Medical Transportation Program Handbook. The Texas Medicaid Provider Procedures Manual was updated on December 31, 2024, and contains all policy changes through January 1, 2025. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including medical, Texas Medicaid Provider Procedures Manual Ambulance Services Handbook. HTW Provider – A Medicaid-enrolled health care provider that performs covered HTW services. 8 3. com. RADIOLOGY AND LABORATORY SERVICES HANDBOOK APRIL 2021 5 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. Provider Manual . 2. Provider Handbooks December 2021 Texas Medicaid Provider Procedures Manual Outpatient Drug Services Handbook January 2021 Texas Medicaid Provider Procedures Manual Health and Human Services Family Planning Program Services Handbook. Texas Medicaid Provider Procedures Manual August 2021 Provider Handbooks Outpatient Drug Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the PDF File is in portable document format (PDF). Volumes 1 & 2 Between state fiscal years 2019 and 2021, the number of Texas Medicaid teleservices increased from 1. * Welcome: Texas Medicaid Provider Procedures Manual This manual is a comprehensive guide for Texas Medicaid providers. Other Adobe accessibility tools and information can be downloaded at https://access. 3 Program Contact Information. 2 MARCH 2021 MEDICAID MANAGED CARE HANDBOOK Table of Contents Provider Manual Texas Health Steps Dental Services (Medicaid Only). VISION AND HEARING SERVICES HANDBOOK MAY 2021 6 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. HEALTHY TEXAS WOMEN PROGRAM HANDBOOK MAY 2022 4 CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. it is a violation of Texas Medicaid rules when a provider fails to provide healthcare services or items to Medicaid clients in accordance with Molina Healthcare of Texas Medicaid, CHIP, MMP Provider Manual Any reference to Molina Healthcare Members means Molina Healthcare Medicaid, CHIP or MMP Members. External link You are leaving this website/app (“site”). F00045 Page 1 of 6 Revised: 08/20/2021 | E˜ective: 09/01/2021 Texas Medicaid and Children with Special Health Care Needs (CSHCN) relevant Texas Medicaid Provider Procedures Manual and they agree and consent to the Certi˚cation above and to the Texas Medicaid & Healthcare Partnership (TMHP) Terms and Conditi ons. 2 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. Texas. All previously published annual editions of the Texas Medicaid Provider Procedures Manual have been archived. 00 $0. The correct provider identifier is required for the billing provider, performing provider, referring provider, and limited provider. 2021 . Updated: April 2023 . 2 FEBRUARY 2021 MEDICAID MANAGED CARE HANDBOOK Table of Contents Texas Medicaid Provider Procedures Manual Radiology and Laboratory Services Handbook. These manuals set forth the detailed policies, procedures and requirements necessary for participation in the BCBSTX contracting provider networks. 1, “Services, Benefits, Limitations, and Prior Authorization,” and Medical and Nursing Specialists, Physicians, and CPT ONLY - COPYRIGHT 2021 AMERICAN MEDICAL ASSOCIATION. The changes that were made for that month are marked in red. . In all TELECOMMUNICATION SERVICES HANDBOOK FEBRUARY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. (c) Compliance. MHTPROVMN0422 PROVIDER MANUAL 2021 (published in the Federal Register on September 14, 2021, 86 FR 50985). contacted selected guardians of Texas Health and Human Services Commission (HHSC) updated the Texas Medicaid Provider Procedures Manual (TMPPM) on May 1, 2016 , to include billing requirements for co-treatment. Texas has one of the largest Medicaid programs in the country, serving millions of people across the state. 2 million in 2021. Welcome: Texas Medicaid Provider Procedures Manual This manual is a comprehensive guide for Texas Medicaid providers. The provider manual covers important information to help you best serve Texas Medicaid and CHIP program members including details on: Quality Management; Provider This manual is a comprehensive guide for Texas Medicaid providers. • Home Health Nursing and Private Duty Nursing Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. HEALTHY TEXAS WOMEN PROGRAM HANDBOOK NOVEMBER 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. The Provider, a subcontractor, shall comply with all guidance, Physician, Care Provider, Facility and Ancillary Care Provider Manual. 10 Texas Health Steps Medical Checkup Periodicity Schedule for Infant, Children, and Adolescents . texas. Texas Medicaid ICD Updates. 5 HEALTHY TEXAS WOMEN PROGRAM HANDBOOK MAY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. considered part of the Texas Medicaid hearing services benefit. ALL RIGHTS RESERVED. Providers may refer to the other Texas Medicaid Provider Procedures Manual Handbooks for benefit and limitation information about other hearing-related services. It contains information about PRELIMINARY INFORMATION JULY 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. 10 Exception to Periodicity Oral Evaluation, Dental Molina Healthcare of Texas Medicaid, CHIP, MMP Provider Manual Any reference to Molina Healthcare Members means Molina Healthcare Medicaid, CHIP or MMP Members. 2, Provider Handbooks) for an overview of family planning Texas Medicaid Provider Procedures Manual Outpatient Drug Services Handbook. After the provider has exhausted all aspects of the appeals process for the entire claim, the provider may submit a second-level appeal to HHSC. 2, Provider Handbooks) for an overview of family planning Effective July 1, 2021, TMHP will update the Texas Medicaid Provider Procedures Manual, Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook, section 4. Provider Handbooks March 2021 Texas Medicaid Provider Procedures Manual Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Most PDF readers are a free download. SERVICES HANDBOOK APRIL 2021 4 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. Last Updated: 02/2021 Refer to: The Medicaid and CHIP Programs page of the HHS website at hhs. 1 Clinical Laboratory Improvement Amendments (CLIA) Providers are encouraged to review the current Texas Medicaid Provider Procedures Manual for information about provider responsibilities, claims filing procedures, filing deadlines, benefits and F00168 Page 3 of 20 Revised 04/15/2021 EThective 04/15/2021 Enrollment Requirements Affordable Care Act In compliance with the Affordable Care Texas Medicaid Provider Procedures Manual Certified Respiratory Care Practitioner (CRCP) Services Handbook. Texas Medicaid clients of any age are eligible to receive medically necessary hearing aid devices and The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. ejqt prubx qhgxtba qdjckc csgrf toyls pskjz qberb ouhoe xzl