Contact Us

• Learn more about prior authorizations.
• Access PA on the Portal.
• If you have questions about prior authorization requests, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.

Important: You cannot file claims, appeals nor administrative reviews through the complaint process.

Claims

• View claim status in TexMedConnect.
• You can file claims on paper or electronically. To learn more about claims, consult the “claims” section of the Texas Medicaid Provider Procedures Manual or the Children with Special Health Care Needs Services Program Provider Manual.
• If you need additional claim status and denial information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.

Administrative Appeals (for Medicaid providers)

• You may file appeals through the following methods:
• Electronically—through your TMHP My Account.
• Phone—through the TMHP Contact Center at 1-800-925-9126. Please note that some claims cannot be appealed by phone.
• By mail—find the correct address in the “appeals” section of the Texas Medicaid Provider Procedures Manual.

Administrative Reviews (for CSHCN Services Program providers)

• You may submit an Administrative Review within 30 days of the date of the denied authorization.
• You may submit through the following methods:
• Fax at 1-512-776-7238.
• By mail—find the correct address in the “appeals” section of the Children with Special Health Care Needs Services Program Provider Manual.

• You can verify client eligibility using the Automated Inquiry System (AIS), the Interactive Voice Response (IVR), or through a representative by calling the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.

• Learn more about EDI.
• Learn more about TexMedConnect.
• If you need help with claim rejections, issues with your account, or other questions, call the TMHP EDI Help Desk at 1-888-863-3638.

• For general information about EVV, go to the TMHP EVV page. You can also visit the Texas Health and Human Services’ EVV page of hhs.texas.gov/.

• Learn more about provider enrollment.
• If you have additional questions about provider enrollment, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.

Fair Hearings

Fair Hearings
Texas Medicaid & Healthcare Partnership
PO Box 204270
Austin, TX 78720-4270

Receiving a Bill

• Call your provider's office right away to make sure they know you or your child are on Medicaid or the CSHCN Services Program and that they have your client ID number.
• If the provider is not enrolled or you do not have coverage for the date(s) of service, you will be responsible for the bill.
• If the provider is enrolled and you are covered for the date(s) of service, follow the steps under the “If You Receive a Bill…” section of the TMHP Contact page.
• TMHP is unable to assist with refund requests for any monies that you have paid to a provider. Medicaid can only pay enrolled providers for the services they perform. You will need to contact the provider directly to request a refund.
• Request assistance from TMHP by forwarding the bill(s) to the Client Correspondence Unit. Please note that collection statements are not considered bills. Your request must include the following:
• Client’s name
• Client’s Medicaid number
• Date of service
• Provider’s name
• Provider’s address (as it appears on the bill)
• Provider’s telephone number


Mail your request to:


Client Correspondence Unit
Texas Medicaid & Healthcare Partnership
PO Box 202018
Austin, TX 78720-2018

Verify Eligibility/Request a Card

• Check eligibility.
• Request benefit card.

Other