The Texas Medical Assistance (Medicaid) Program was implemented September 1, 1967, under the provisions of Title XIX of the Federal Social Security Act and Chapter 23 of the Texas Human Resources Code. The cost of Medicaid is shared by the State of Texas and the federal government. The Texas Health and Human Services Commission (HHSC), the single state Medicaid agency, is responsible for the Title XIX Program.
The administration of the program is accomplished through contracts and agreements with medical providers, claims administrators (claims reimbursement processor), enrollment brokers, various managed care organizations, and state agencies including the Department of Assistive and Rehabilitative Services (DARS), and Department of State Health Services (DSHS). Medicaid providers, including those providing Texas Health Steps services, are reimbursed for their services through contracts with health-insuring contractors, fiscal agents, or direct vendor payments.
How It Works
Qualified medical and dental providers enroll in Medicaid and indicate on the enrollment form that they will be providing Texas Health Steps services.
A nine-character Texas Provider Identifier (TPI) is issued to the provider by the Claims Administrator (Texas Medicaid & Healthcare Partnership). This identifier is very important since it is used when filing claims for reimbursement for providing Texas Health Steps services.
Locally field-based Texas Medicaid & Healthcare Partnership (TMHP) Medicaid Provider Relations Representatives are available to assist and train Medicaid providers. These Provider Relations Representatives provide education and training on claims submission for new and existing Medicaid providers. Technical support and training also are provided for TDHconnect software users. To find how and where to request this type of assistance and training, visit the TMHP Provider Education web page. In addition regionally-based Department of State Health Services (DSHS) Texas Health Steps (THSteps) Provider Relations Representatives are available to respond to Medicaid providers' questions and problems. To find how and where you may request this type of assistance, visit the Texas Health Steps Health Service Regions web page.
Texas Health Steps Outreach and Informing staff contact newly enrolled Texas Health Steps recipients to inform them of the services to which they are entitled; to encourage them to use the Texas Health Steps preventive medical and dental checkup services; to provide them with a list of all Texas Health Steps providers in their area, and; to assist them in setting an appointment for a medical and/or dental checkup.
At the time of their appointment, recipients present their Medicaid ID to their provider and receive their medical and dental checkups from and establish a medical or dental home with their Texas Health Steps provider. Should additional acute care be needed as a result of the checkup, these services are also provided and providers receive reimbursement for providing them.
The Provider submits an electronic or paper claim form to the Claims Administrator for reimbursement. Deadlines for submitting claims: 95 days for in-state providers and 365 days for out-of-state providers.
The Provider receives reimbursement from the Claims Administrator.
NOTE: This is brief summary of the process. For more details and the required enrollment and reimbursement forms and how to complete them, please visit the Provider Section of the TMHP website and refer to the Texas Medicaid Provider Procedures Manual (TMPPM).