Date: August 21, 2025
Attention: Providers
Effective date: September 1, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of an important update to a provider alert published. The original TMHP Bulletin was published on July 24, 2025 and it contained incorrect information in the Dialysis Services spreadsheet. The affected spreadsheet has been updated and now features the correct reimbursement information. Here is the link to the correct spreadsheet, Dialysis Services.
How this impacts providers: Effective for dates of service on or after September 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the reimbursement rate changes and updates for the procedure codes that were presented at the public rate hearing on May 27, 2025.
Texas Medicaid managed care organizations (MCOs) like TCHP must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO/TCHP. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should reference a member’s specific MCO/TCHP for information on these items. For TCHP, this information can be found on the provider page available here https://www.texaschildrenshealthplan.org/providers
Next step for Providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.