Medicaid Coverage Changes are Coming
Learn how to help your patients with renewing their coverage
For Providers
Attention Providers!
Prior Authorization requirements will be changing in 2024. Please review them now in preparation. Click here to view the requirements that will become effective in January 2024.
A new single state funded Electronic Visit Verification (EVV) vendor system, HHAeXchange, is launching October 1, 2023.
On April 26, 2022, the Texas Health and Human Services Commission (HHSC) posted a solicitation for EVV System Management Services. Through a competitive selection process, HHSC has selected Accenture State Healthcare Services LLC. Accenture will continue to be known as the Texas Medicaid & Healthcare Partnership (TMHP) for this contract. Accenture is partnering with HHAeXchange to provide a new, single EVV vendor system.
To learn more, visit the Electronic Visit Verification (EVV) page and view the Provider Alert
The Texas Vendor Drug Program (VDP) have made recent changes to Texas Medicaid drug formulary. This will be in effect July 27, 2023 on select medication(s) moving from “preferred” to “non-preferred” status and vice-versa.
To learn more about formulary changes impacted, please click here for more information.
Network providers must maintain their enrollment and demographic information with Texas Medicaid Healthcare Partnership (TMHP). Provider Medicaid enrollment functions are available through Provider Enrollment and Management System (PEMS). Updates to provider’s current enrollment, new practice locations or change of ownership updates, can be made on this site titled ”Provider Enrollment and Management System (PEMS)”, accessible here.
For instructions on how to make other demographic updates to your current enrollment, access the site titled “Provider Enrollment Help”, accessible here.
Click here to view the Provider Alert.
Our website for providers is designed as a tool to help you. You can find an array of resources such as:
- Pharmacy Directories
- Downloadable forms
- Claims information
- Practice guidelines
- Provider Newsletters
- Contracting and Credentialing
Provider Manuals
Helpful links
- Medicaid Autism Services Flyer: Applied Behavior Analysis Services
- Screening and Coding for Social Determinants of Health
- Texas Health and Human Services
- Texas Health Steps Culturally Effective Health Care online course
- Texas Health Steps Additional Courses
- Texas Health Steps Provider Information
- Texas Health Steps Regional Representative Contact List
- Texas Medicaid/CHIP Vendor Drug Program
- Texas Medicaid & Healthcare Partnership
Member Rights and Responsibilities
Clinical and Administrative Advisory Committee, Behavioral Health Advisory Committee, Perinatal Advisory Committee
These Provider Advisory Groups provide recommendations to Texas Children’s Health Plan in the following areas:
- Identification and review of clinical practice guidelines and prior authorization guidelines;
- Review of general utilization patterns and assessment of Provider compliance with clinical guidelines;
- Recommendations for member engagement and quality improvement programs to improve health outcomes and keep members healthy
- Strategies and recommendations for improving Health Plan administrative processes;
- Recommendations on how to improve care based on Member feedback and their personal experiences serving our Members; and
- Opportunities for connecting network Providers and Managed Care Organization clinical experts for purposes of peer support and sharing best practices.
There is a Clinical and Administrative Advisory Committee for each of our three Service Areas:
- Harris
- Jefferson
- Rural Service Area Northeast
The Behavioral Health Advisory Committee and Perinatal Advisory Committee meet in the Harris Service Area.
The meeting cadence for each of the committees are as follows:
- Clinical and Administrative Advisory Committee meets 9 times per year in the Harris Service Area and quarterly in the Jefferson and Rural Service Area Northeast
- Behavioral Health Advisory Committee meets quarterly
- Perinatal Advisory Committee meets quarterly