Billing Reminders Based on Texas Medicaid (HHSC/TMPPM) Requirements

Date: March 10, 2026 

Attention: Providers

Call to action: Texas Children’s Health Plan (TCHP) follows the Texas Medicaid Provider Procedures Manual (TMPPM) billing requirements.

Billing requirements for Box 24J are as follows.

The TMPPM confirms that claims submitted to Texas Medicaid must follow CMS1500 and NUCC standards, including accurate identification of the rendering provider in Box 24J.

For individual professional services, the rendering provider’s individual NPI must be reported in Box 24J.

• The billing entity or group NPI must be reported separately in Box 33A, when applicable.
• Texas Medicaid does not require TPI or other legacy identifiers on electronic claims, unless otherwise instructed for specific program exceptions. [tmhp.com]

Managed Care (UMCM) Alignment
Under the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM), Managed Care Organizations are required to apply uniform billing and claims standards consistent with CMS and TMPPM requirements. As such, claims submitted to Medicaid MCOs must also reflect: [hhs.texas.gov]

• The correct rendering provider NPI in Box 24J, and
• The appropriate billing provider NPI in Box 33A, consistent with the provider’s enrollment and contract status.

Source:TMPPM, SECTION 6: CLAIMS FILING

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org. 

For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.