Date: March 27, 2025
Attention: Providers
Effective date: January 1, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like to notify providers that effective for dates of service on or after January 1, 2025, reimbursement rate updates for Medical Transportation Program (MTP) and Indian Health Service (IHS) procedure codes that were presented at the public rate hearing on February 14, 2025, will be implemented.
To view the updates, access the following spreadsheets:
How this impacts providers: As you may know, 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.
Claims information: The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless they are denied for additional reasons after reprocessing is completed.
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: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.