Texas Medicaid Provider Procedures Manual definition

Texas Medicaid Provider Procedures Manual means the policy and procedures manual published by or on behalf of HHSC that contains policies and procedures required of all health care providers who participate in the Texas Medicaid program. The manual is published annually and is updated bi­monthly by the Texas Medicaid Bulletin.
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Texas Medicaid Provider Procedures Manual. All references to “THSteps” are changed to “Texas Health Steps” Section 8.1.1.1 is modified to update Goal 3, change SFY2007 to SFY2010, and clarify the applicability of Goals 1 and 2. Section 8.1.2 is modified to delete the reference to the Texas Health Steps Manual. Section 8.1.3.1 is amended to change from checkup requirement from “60” days to “90” days and to replace the reference to the AAP periodicity schedule with the Texas Health Steps periodicity schedule. Section 8.1.3.2 is revised to provide additional clarity as it relates to Qualified Mental Health Providers – Community Services (QMHP-CS). Section 8.1.4.2 is amended to change the reference from the “THSteps Manual” to the “Texas Medicaid Provider Procedures Manual” and to clarify requirements for CHIP and Medicaid. Section 8.1.17.2 is modified to require CHIP and CHIP Perinatal HMOs to submit TPR reports. Section 8.1.18.1 is modified in compliance with HB 1218 to require HMOs to submit encounter data not later than the 30th day after the last day of the month in which the claim was adjudicated. Section 8.1.20.2 (j) is modified to remove the references to “annual”, change “check-ups” to checkups”, and change “90-Day XXXX Report” to “Xxxx 90-Day Reports”. Section 8.1.20.2 (l) Xxxx Quarterly Monitoring Report is added. Section 8.1.20.2 (m) Xxxx Health Care Provider Training Report is added. Section 8.2.2.2 is amended to prohibit HMO from requiring pre-authorization for family planning services. Section 8.2.2.3 is amended to change from checkup requirement from “60” days to “90” days; change the periodicity schedule from “AAP” to “Texas Health Steps”; remove the reference to the Texas Department of Transportation; add “Corrective Action Orders” to the training requirements; change “DSHS THSteps outreach staff” to “the Texas Health Steps outreach unit”; change “again within two weeks from the time of birth” to “in accordance with the Texas Health Steps periodicity schedule”; change “two-week follow-up” to “newborn follow ups”; to spell out the acronym for ACIP; and change “HCFA 1500” to “CMS 1500”. Section 8.3.2.8 is added to require all STAR+PLUS plans to provide or have applied to provide MA/SNP services in all counties in which they offer STAR+PLUS services. Section 8.3.5 is amended to change the name from “Personal Attendant Services” to “Consumer Directed Services Options” and “In-Home or Out-of-Home Respite” is added as an option. Section 8.3.5.1 is amended to delete “Personal Attendant Servi...
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Texas Medicaid Provider Procedures Manual means the policy and procedures manual published by or on behalf of HHSC that contains policies and procedures required of all health care providers who participate in the Texas Medicaid program. The manual is published annually and is updated bi-monthly by the Texas Medicaid Bulletin. Texas Public Information Act refers to the provisions of Chapter 552 of the Texas Government Code. Third Party Liability (TPL) means the legal responsibility of another individual or entity to pay for all or part of the services provided to Members under the Contract (see 1 TAC §354.2301 et seq., relating to Third Party Resources).
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Examples of Texas Medicaid Provider Procedures Manual in a sentence

  • For more information, consult 1 TAC §371.1659.Texas Medicaid providers must follow the coding and billing requirements of the Texas Medicaid Provider Procedures Manual (TMPPM).

  • The HMO must provide, or arrange to have provided, to Members all Medically Necessary Behavioral Health (BH) Services as described in Attachments B-2, B-2.1, and B-2.2. All BH Services must be provided in conformance with the access standards included in Section 8.1.3. For Medicaid HMOs, BH Services are described in more detail in the Texas Medicaid Provider Procedures Manual and the Texas Medicaid Bulletins.

  • These include the Texas Medicaid Provider Procedures Manual and banner messages, which are included in R&S Reports.• All adopted agency rules.

  • The current Texas Medicaid Provider Procedures Manual (Provider Manual) may be accessed via the internet at www.tmhp.com.

  • These include the Texas Medicaid Provider Procedures Manual and banner messages, which are included in R&S Reports.

  • Providers should refer to the Texas Health Steps Online Provider Training Modules referencing specimen collection on the DSHS website and the Texas Medicaid Provider Procedures Manual, Children's Services Handbook for the most current information and any updates.

  • The Texas Health Steps online provider training modules referencing specimen collection on the DSHS website and the Texas Medicaid Provider Procedures Manual, Children Services Handbook, should be referenced for the most current information and any updates.

  • The current Texas Medicaid Provider Procedures Manual (Provider Manual) may be accessed via the internet at xxx.xxxx.xxx.

  • This contract includes this document and all amendments and appendices to this document, the Request for Application, the Application submitted in response to the Request for Application, the Texas Medicaid Provider Procedures Manual and Texas Medicaid Bulletins addressed to HMOs, contract interpretation memoranda issued by TDH for this contract, and the federal waiver granting TDH authority to contract with HMO.

  • For Members who move from STAR, STAR+PLUS, or the Dual Demonstration into STAR Health, the date of Discharge from the Hospital for behavioral health stays includes extended stay days, as described in the Texas Medicaid Provider Procedures Manual.


More Definitions of Texas Medicaid Provider Procedures Manual

Texas Medicaid Provider Procedures Manual means the policy and procedures manual published by or on behalf of HHSC, which contains policies and procedures required of all health care providers who participate in the Texas Medicaid program. The manual is published annually and is updated bi-monthly by the Medicaid Bulletin.
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Related to Texas Medicaid Provider Procedures Manual

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  • MERS Procedures Manual The MERS Procedures Manual, as it may be amended, supplemented or otherwise modified from time to time.

  • Procedures Manual means the standards and procedures manual described in Section 11.3.

  • Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.

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  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Medicaid program means the medical assistance

  • MERS Procedure Manual The MERS Procedures Manual, as it may be amended, supplemented or otherwise modified from time to time.

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  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

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