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	Global Surgical Periods to Change for Texas Medicaid Information posted March 5, 2010: Effective for dates of service on or after May 1, 2010, the global surgical period and the usage of certain modifiers will change for Texas Medicaid. Click on the title to view the details.
	New Reports for Claim Activity by MHMR Providers Information posted March 5, 2010: Beginning March 16, 2010, new claim activity reports will be available for Mental Health and Mental Retardation (MHMR) services providers. The first of these new reports will cover claims submitted from September 1, 2009, through February 28, 2010. Subsequent reports will cover claim activity for individual months. Click on the title to view the details.
	Providers Must Have Correct Physical Address on File Information posted March 5, 2010: Reminder: The Medicaid provider agreement requires providers to keep their correct physical address on file with TMHP. The physical address is also used in the Online Provider Lookup (OPL) so that clients can locate providers. Providers who practice at multiple locations are required to enroll each location at which health-care services will be rendered. It is important that each location’s correct physical address and phone number are available on the OPL. Click on the title to view the details.
	Non-Attested TPIs Without Claims or Encounters for at Least 24 Months to Be End-Dated Information posted March 5, 2010: TMHP is collaborating with the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS) to improve provider information databases by removing inactive provider records. Click on the title to view the details.
	Global Surgical Periods to Change for the CSHCN Services Program Information posted March 5, 2010: Effective for dates of service on or after May 1, 2010, the global surgical period and the usage of certain modifiers will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
	Computed Tomography Benefit to Change for the CSHCN Services Program Information posted March 5, 2010: Effective for dates of service on or after May 1, 2010, computed tomography (CT) benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
	Claims Reprocessing of Procedure Code E0240 Information posted March 5, 2010: TMHP has identified an issue that affects claims submitted by durable medical equipment providers with dates of service from January 1, 2010, through March 9, 2010, and procedure code E0240. Procedure code E0240 will no longer be reimbursed at a rate of $95.00 and will be manually priced based on the modifier submitted on the claim. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. For more information, call the TMHP Contact Center at 1-800-925-9126.
	New Banner Messages Are Available Information posted March 5, 2010: Banner messages containing important informational updates regarding the Medicaid, Managed Care, Family Planning, and CSHCN Services Programs appear on the providers' Remittance and Status (R&S) reports each week. Click on the title to view this week's banner messages
	New Banner Messages Are Available Information posted February 26, 2010: Banner messages containing important informational updates regarding the Medicaid, Managed Care, Family Planning, and CSHCN Services Programs appear on the providers' Remittance and Status (R&S) reports each week. Click on the title to view this week's banner messages.
	TMHP to Update the Field Description on the Static Fee Schedule Information posted February 26, 2010: Beginning May 3, 2010, TMHP will update the field description for “Access-Based or Max Fee” on the static fee schedule. Click on the title to view the details.
	Clarification to “Behavioral Health Services Performed by LPAs Are Benefits" Information posted February 26, 2010: This is a clarification to an article that was published on this website on July 24, 2009, and in the November/December 2009 Texas Medicaid Bulletin, No. 226, titled “Behavioral Health Services Performed by Licensed Psychological Associates Are Benefits.” Psychological and neuropsychological testing may be reimbursed to providers for the time spent face-to-face with the client and also the time spent on scoring and interpreting the testing. Click on the title to view the details.
	Provider Enrollment on the Portal (PEP) Enhancements Coming in May Information posted February 26, 2010: Enhancements to Provider Enrollment on the Portal (PEP) will be implemented on May 3, 2010. Click on the title to view the details.
	Medicaid Reimbursement Rates to Change for Some DME Services Information posted February 26, 2010: Effective for dates of service on or after April 1, 2010, reimbursement rates will change for some durable medical equipment (DME) services procedure codes. Click on the title to view the details.
	Correction to “Update to Reimbursement Rates for Some Respiratory System Surgery Services” Information posted February 26, 2010: This is a correction to an article that was posted on this website on February 5, 2010, titled “Update to Reimbursement Rates for Some Respiratory System Surgery Services.” The article incorrectly listed some procedure codes as a benefit for assistant surgery. Procedure codes 31705, 31205, and 31420 are not payable as assistant surgery benefits.
	Update to “WHP Certification Form Final Deadline” February 26, 2010: Reminder: All providers that have submitted claims for Women’s Health Program (WHP) services must return the WHP Certification Form, by fax or mail, by 12:00 p.m., Central Time, March 5, 2010, regardless of the provider’s intent to participate in the program in the future. Click on the title to view the details.
	End Date for RSV Prophylaxis Extended to March 31, 2010 Information posted February 25, 2010: The last date on which to administer the five prior-authorized doses of palivizumab prophylaxis has been extended to March 31, 2010. As additional RSV virology data become available, the time to administer the five doses may be adjusted again. Click on the title to view the details.
	WHP Certification Form Final Deadline Information posted February 23, 2010: The Texas Health and Human Services Commission (HHSC) has extended the deadline for submission of the Medicaid Women’s Health Program (WHP) Certification form to 12:00 p.m., Central Standard Time on March 5, 2010. TMHP will place a payment hold on all Medicaid fee-for-service claims filed by, or on behalf of, any billing provider who fails to respond by this date. Click on the title to view the details.
	Reimbursement Rates for Some Procedure Codes Will Change April 1, 2010 Information posted February 19, 2010: Effective for dates of services on or after April1, 2010, reimbursement rates for the following services will change for Texas Medicaid: physician-administered drugs; radiation oncology; cardiovascular services; digestive system services; male genital system services; female genital system services; urinary system services; auditory system services; radiology services; additional surgery services; and miscellaneous services. Click on the title to view the reimbursement rates tables.
	CSHCN Services Program Reimbursement Rates to Change for Some Vision-Related Services Information posted February 19, 2010: Effective February 11, 2010, for dates of service on or after December 1, 2009, the reimbursement rates for vision related services procedure codes V2020 and V2025 changed for the Children with Special Health Care Needs (CSHCN) Services Program. Affected claims with dates of service on or after December 1, 2009, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details.
	Update to “Benefit Update for Obstetrics Services Policy” Information posted February 19, 2010: This is an update to an article that first appeared on the December 11, 2009, Remittance and Status (R&S) Report, and to a web article that was published on this website on December 4, 2009, titled “Benefit Update for Obstetrics Services Policy.” Effective for dates of service on or after April 1, 2010, procedure code 99215 is no longer a benefit in place-of-service (POS) 7, birthing center. Procedure codes 99204 and 99213 are replacing procedure code 99215 and will be payable in place-of-service 7 to physicians and certified nurse midwives (CNM). The higher reimbursement rate in POS 7 allows CNMs and physicians to compensate the birthing center for the use of the facility. Click on the title to view the details.
	CSHCN Services Program Orthoses and Prostheses Benefits to Change Information posted February 19, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for orthoses and prostheses will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
	CCP Benefits to Change for Orthoses and Prostheses Information posted February 19, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for orthoses and prostheses will change for the Texas Medicaid Comprehensive Care Program (CCP). Click on the title to view the details.
	Augmentative Communication Device Benefit Criteria to Change for the CSHCN Services Program Information posted February 19, 2010: Effective for dates of service on or after April 1, 2010, benefit criteria for augmentative communication devices (ACDs) will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
	CSHCN Services Program Benefits to Change for Vision Services Information posted February 19, 2010: Effective for dates of service on or after April 1, 2010, some visions services benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
	Medicaid Benefits to Change for Nonsurgical Vision Services Information posted February 19, 2010: Effective for dates of service on or after April 1, 2010, benefit criteria for nonsurgical vision services will change for Texas Medicaid. Click on the title to view the details.
	Benefit Criteria to Change for Bath and Bathroom Equipment - Home Health Services Information posted February 19, 2010: Effective for dates of service on or after April 1, 2010, benefit criteria for bath and bathroom equipment will change for Texas Medicaid. Click on the title to view the details.
	Title XX Claims Filing Procedures for WHP Wrap-Around Services Information posted February 19, 2010: Federally qualified health centers (FQHCs) may now receive Title XX reimbursement for Women’s Health Program (WHP) wrap-around services that are provided during a visit where the primary purpose of the visit is not related to contraception and so is not covered under the WHP. Click on the title to view the details.
	Navigation Reminder for Provider Enrollment on the Portal Information posted February 19, 2010: When using Provider Enrollment on the Portal (PEP), providers must not use the “Back” button on the Microsoft Internet Explorer browser window to navigate through any of the provider enrollment applications. Using the “Back” button causes information to be removed from the application when it is submitted. Providers must navigate using only the “Previous” and “Continue” buttons that are embedded in each page of an online application. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
	Family Planning Funds Gone - Accounts Receivable Reconciliation Process Information posted February 19, 2010: Beginning with state fiscal year (SFY) 2010, Budget Period 1, TMHP will implement a new Funds Gone - Accounts Receivable reconciliation process for claims that are submitted by Family Planning Titles V and XX providers. Click on the title to view the details.
	Home Health Fee Schedule and Online Fee Lookup Information posted February 19, 2010: TMHP has identified an issue with the home health static fee schedules and online fee lookup (OFL). Click on the title to view the details.
	Changes to Global Surgical Periods Are Coming Information posted February 19, 2010: TMHP is in the process of aligning reimbursement for global surgical periods for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program with the Centers for Medicare & Medicaid Services (CMS) standard method of billing. Details will be made available as the implementation date approaches. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
	Texas Medicaid Benefit Criteria to Change for Some Vision Surgical Services Information posted February 19, 2010: Effective for dates of services on or after April 1, 2010, benefit criteria for some vision surgical services will change for Texas Medicaid. Click on the title to view the details.
	Augmentative Communication Device Benefit Criteria to Change for Texas Medicaid Information posted February 19, 2010: Effective for dates of service on or after April 1, 2010, benefit criteria for augmentative communication device systems (ACDs) will change for Texas Medicaid. Click on the title to view the details.
	Correction to “Update to Out-of-State Providers Who Perform Services to Migrant Farm Workers” Information posted February 12, 2010: This is a correction to an article that was posted on the TMHP website at www.tmhp.com on December 31, 2009, titled “Update to Out-of-State Providers Who Perform Services to Migrant Farm Workers.” Click on the title to view the details. or border-state providers that render serv
	Medical, Surgery, Assistant Surgery, and DME Services Reimbursement Rates Have Changed Information posted February 12, 2010: Effective for dates of service on or after January 1, 2010, some medical, surgery, assistant surgery, and durable medical equipment (DME) services reimbursement rates have changed for Texas Medicaid. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details.
	Benefits for Home Health Power Wheelchairs to Change Information posted February 12, 2010: Effective for dates of service on or after March 1, 2010, the prior authorization criteria for home health power wheelchairs will change for Texas Medicaid. Click on the title to view the details.
	Claims Filing and Reimbursement Reminder for Hearing Services Providers Information posted February 12, 2010: Reminder for hearing services providers: The date of service indicated on the claim for the hearing device procedure code must be the date the device is dispensed to the client. Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program reimburse providers only for rendered services and for equipment and supplies received by the client. Future services and undelivered equipment and supplies cannot be billed for reimbursement. Click on the title to view the details.
	Obtaining Authorization for Outpatient Radiology Services Information posted February 12, 2010: Reminder: Outpatient diagnostic radiology services, including computed tomography (CT), magnetic resonance (MR), positron emission tomography (PET), and cardiac nuclear imaging, require prior authorization for Texas Medicaid fee-for-service clients and Primary Care Case Management (PCCM) clients. Authorization requests must be submitted to MedSolutions, which is the TMHP subcontractor that authorizes radiology services for Texas Medicaid clients. Click on the title to view the details.
	Provider License Renewal Reminder Information posted February 12, 2010: Reminder: To continue to participate in Texas state health-care programs, providers who are licensed or certified to practice in Texas must provide TMHP with proof of a current license or certification. TMHP receives licensure information directly from the Texas Medical Board, the Texas State Board of Dental Examiners, and the Texas Board of Nursing. Providers who are licensed by these three boards do not need to provide TMHP with renewal information. All other licensed providers must send TMHP their updated licensure or certification when it is renewed. Click on the title to view the details.
	Claims Reprocessing for Women’s Health Program Information posted February 12, 2010: TMHP has identified an issue that impacts claims submitted under the Women’s Health Program in fiscal years 2008 and 2009. Claims submitted by ambulance providers, podiatrists, and hospitals might have been incorrectly reimbursed under WHP. Reimbursed amounts for affected claims might be recouped. No action on the part of the provider is required. For more information, call the TMHP Contact Center at 1-800-925-9126.
	Informational Claims Submissions Transitions to TMHP Information posted February 12, 2010: Effective February 22, 2010, Informational Claims processing will transition from the Health and Human Services Commission (HHSC) to TMHP. Click on the title to view the details.
	TMHP System Maintenance Schedule for February 14 Information posted February 11, 2010: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on Sunday, February 14, 2010, from 6:00 p.m. until midnight Central Time. During the system maintenance window, some applications will be unavailable for both Acute Care and Long Term Care systems. Click on the title to view the details.
	Online Provider Lookup Enhancements Coming in February Information posted February 10, 2010: The Online Provider Lookup (OPL) is being enhanced to improve overall functionality. These enhancements will be implemented on March 1, 2010. Click on the title to view the details.
	Update to “Stem Cell Transplants Benefits to Change for the CSHCN Services Program” Information posted February 5, 2010: This is an update to the article published on the TMHP website at www.tmhp.com, on January 22, 2010, titled, “Stem Cell Transplants Benefits to Change for the CSHCN Services Program.” Click on the title to view the details.
	Update to “Reimbursement Rates for Some Respiratory System Surgery Services Procedure Codes.." Information posted February 5, 2010: This is an update to an article that was posted on this website on January 15, 2010. The article incorrectly indicated that effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates would change for some respiratory system surgery services procedure codes. The updated information is that reimbursement rates for some respiratory system surgery services procedure codes were effective January 1, 2010, and others will become effective on March 1, 2010 or April 1, 2010. Click on the title to view the updated rates.