In an effort to administratively simplify Medicaid claims submission, the Texas Health and Human Services Commission (HHSC) is creating a single source claims portal that Community Health Choice (CHC) Providers may use to submit claims. The claims portal was announced in an article published on December 1, 2011 on the TMHP Web site. Read the article on CHC’s website at www.CHCHealth.org > Provider News.
Summary
Effective for dates of services on or after March 1, 2012, Providers will be able to submit electronic claims to TMHP for services to Medicaid clients whose benefits are administered by a Medicaid managed care Organization (MCO). TMHP will accept Medicaid claims submissions and forward the claims as necessary to the correct MCO based on the client’s eligibility on file.
Providers who have contracted with more than one MCO plan will no longer need to separate their Medicaid claims for submission through different channels. Providers can choose to continue to submit claims directly to the appropriate entity. When submitting claims directly to CHC, Providers must follow the guidelines established by CHC for claims submissions. Review CHC’s guidelines on their website at www.CHCHealth.org > Providers > Claim Center.
Exceptions
TMHP will not forward the following claims submissions. They must be submitted directly to CHC or to the dental plan that administers the client’s Medicaid managed care benefits:
- Paper claim forms
- Children’s Health Insurance Program (CHIP), including CHIP Perinatal
Please refer to the TMHP article for additional information.
If you have any questions, please contact your IntegraNet Provider Relations Representative.
NCPA – National Center for Policy Analysis
