Quick Course
Texas Medicaid Services for Children
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).
EnrollTo enroll in this course, please log in or create a new account if you are not already registered.
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.
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Health-Care Providers
Provider Publications, Tools, Services and Other Resources
- American Academy of Pediatric Dentistry. (2022). Periodicity of examination, preventive dental services, anticipatory guidance/ counseling, and oral treatment for infants, children, and adolescents. The Reference Manual of Pediatric Dentistry, 253-65.
- American Academy of Pediatric Dentists (AAPD) Periodicity Guidelines
- Child and Adolescent Needs and Strength Assessment
- Navigate Life Texas (available in multiple languages)
- Newborn Screening Provider Resources
- Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home
- Texas Administrative Code (T.A.C. §353.2.71), Definition of “Medically Necessary”
- Texas Department of State Health Services Laboratory Services
- Laboratory Testing Services Manual
- 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 & 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 Provider Enrollment and Management System (PEMS)
- Online Provider Search
- 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
- TexMedConnect
- Texas Medicaid Provider Procedures Manual (TMPPM)
- TMPPM, Children’s Services Handbook
- TMPPM, Comprehensive Care Program (CCP), Chapter 2 of Children’s Services Handbook
- TMPPM, Medicaid Managed Care Handbook
- Carve-Out Services, Section 8
- Texas Pulse Oximetry Project’s Critical Congenital Heart Disease (CCHD) Toolkit
- Texas Vaccines for Children (TVFC)
- TVFC Provider Enrollment
- TVFC & ASN Digest
- TVFC and Adult Safety Net Provider Manual
- 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 Resource Information
- Texas Prior Authorization Call Center, 877-728-3927 (877-PA-TEXAS), Monday to Friday, 7:30 a.m. to 6:30 p.m. Central time
- Texas Health Steps Hotline, 877-847-8377 (877-THSTEPS)
- 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 (including Referral Form)
- 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
- For children, adolescents and young adults who are not enrolled in a Medicaid managed care plan, call Medicaid’s transportation hotline at 877-633-8747 (877-MED-TRIP)
- 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
- HHSC Managed Care Contract Management
- Texas Managed Care Services Areas (map)
- Texas Medicaid and CHIP Reference Guide, 13th Edition (Pink Book)
- Texas Medicaid Caseload by Risk Group, September 2014 – September 2022
- Uniform Managed Care Manual (Medicaid & CHIP)
Texas Medicaid Managed Care Programs