Date: October 2, 2025
Attention: Providers
Effective for dates of service on or after September 1, 2025
Call to action: The Texas Medicaid & Healthcare Partnership (TMHP) does not adjudicate claims submitted by providers for Medicaid-only services that they provide to dual-eligible clients who are enrolled in a managed care organization (MCO) like Texas Children’s Health Plan (TCHP) effective for dates of service on or after September 1, 2025. TMHP forwards the claims to the MCO like TCHP for processing. Claim responses will show that the claims were forwarded, and TMHP will not generate an Electronic Remittance and Status (ER&S) Report.
How this impacts providers: Claim information
Claims for A4335 Rejected
TMHP incorrectly rejected this type of claim if it was submitted from September 1, 2025, to September 4, 2025, with procedure code A4335 and a DOS after September 1, 2025. Providers that submitted a claim that was rejected during this time period should resubmit their claims to TMHP for forwarding.
Single Claims for Multiple Payers
Providers who submit claims using TexMedConnect or electronic data interchange (EDI) must limit them to a single payer. If a claim is submitted with details that are payable by both the MCO and TMHP, TMHP will reject the claim. Providers must submit a separate claim for each payer.
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.
