
Welcome to the training on Texas Medicaid Services for Children provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Note: Health-care provider practices range from solo practitioners to large, multi-specialty groups. Some have entire departments dedicated to checking Medicaid eligibility, submitting and following up on claims, communicating with managed care plans, and credentialing. Others have a limited number of staff members who perform both administrative and clinical duties. Some Medicaid policies and procedures covered in this module may primarily involve administrative staff rather than the clinicians who are taking the training.
Goal
The goal of this module is to equip Texas Health Steps providers and others to follow legal requirements and employ best practices in delivering Texas Medicaid services to children birth through age 20 who are enrolled in Medicaid.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Apply knowledge of the medical and dental services that are available to children enrolled in Medicaid.
- Specify requirements and processes for prior authorization and claims filing and adjudication.
- Evaluate whether a medical service to diagnose or treat a condition would likely meet the definition of medical necessity.
- Appraise whether a child enrolled in Medicaid could also be eligible for services under other Texas state health-care programs for children.
This module was released on 4/16/2020.
Provider Publications, Tools, Services, and Other Resources
- American Academy of Pediatric Dentists (AAPD) Periodicity Guidelines
- Child and Adolescent Needs (CANS 2.0) Assessment (2017)
- Navigate Life Texas
- Newborn Screening Provider Resources
- Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home
- PAXpress/RxPert
- Provider Manual For the Texas Prior Authorization Program (2018)
- Texas Department of State Health Services Laboratory Services
- Submitter Identification (ID) Number Form
- Texas Early Hearing Detection and Intervention (TEHDI)
- Texas Health Steps Medical Checkup Periodicity Schedule for Infants, Children, and Adolescents
- Texas Medicaid Provider Procedures Manual (TMPPM), Volumes 1 and 2
- Children’s Services Handbook, Volume 2
- Medicaid Managed Care Handbook, Volume 2
- Carve-Out Services, Section 8
- Texas Pulse Oximetry Project’s Critical Congenital Heart Disease (CCHD) Toolkit
- Texas Vaccines for Children (TVFC)
- TVFC Provider Enrollment
- Texas Vendor Drug Program (VDP)
- Texas Medicaid Formulary
- Clinical PA Assistance Chart (PDF)
- Texas Medicaid Preferred Drug List
- PDL PA Criteria Guide (PDF)
- Prescriber MCO Assistance Chart (PDF)
- Texas Prior Authorization Call Center
Texas Medicaid & Healthcare Partnership
- Automated Inquiry System (AIS), 800-925-9126.
- Contact Center, 800-925-9126.
- Children with Special Health Care Needs (CSHCN) Services Program Provider Enrollment
- Code Updates
- ICD-10 Code Updates
- Medicaid Client Portal
- Medicaid Provider Enrollment
- Online Provider Lookup
- PA on the Portal
- Pharmacy Provider Enrollment
- Provider Forms
- Provider Relations Regional Representatives
- Texas Health Steps Provider Enrollment, Dental
- Texas Health Steps Provider Enrollment, Medical
- TexMed Connect
- Texas Health Steps Hotline, 877-847-8377
- Catalog
- Forms
- Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home
- Provider Enrollment on the Portal (PEP)
- Texas Health Steps Health Service Regional Provider Relations Representatives contact information
- Texas Health Steps Medical Checkup Periodicity Schedule for Infants, Children, and Adolescents
- Texas Health Steps Quick Reference Guide/Medical Checkup Procedure Codes
Medicaid and Other State Programs Providing Health-Care and Support Services
- Case Management for Children and Pregnant Women
- Children with Special Health Care Needs Services Program (CSHCN)
- Children’s Health Insurance Program (CHIP)
- Community Living Assistance and Support Services (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Early Childhood Intervention (ECI)
- Health Insurance Premium Payment (HIPP)
- Healthy Texas Women (HTW)
- Home and Community-based Services (HCS)
- Medicaid Buy-In (MBI) for Adults
- Medicaid Buy-In for Children (MBIC)
- Medical Transportation Program:
- In all areas except for Houston/Beaumont and Dallas/Fort Worth, families can call Medicaid’s transportation hotline at 877-633-8747 (877-MED-TRIP).
- In Houston/Beaumont area, call: 855-687-4786.
- In Dallas/Fort Worth area, call: 855-687-3255.
- Medically Dependent Children Program (MDCP)
- Medically Needy with Spend Down (MNSD) Program, Section 4.5 of Texas Medicaid Provider Procedures Manual (TPPM), Volume 1
- Texas Home Living (TxHmL)
- Youth Empowerment Services (YES)
Texas Health and Human Services Commission
- HHSC Claims Administrator Contract Management Office
- HHSC Health Plan Management Office
- Medicaid Managed Care Medical and Dental Plans
- Texas Medicaid and CHIP Reference Guide, 12th Edition
- Uniform Managed Care Manual
Texas Medicaid Managed Care Programs
- Medicaid and CHIP Dental Plans
- American Dental Association (ADA) Dental Services Claim Form, 800-947-4746
- STAR Health
- STAR Kids
- STAR Medicaid
- STAR+PLUS