TexMedConnect and My Account Guides (2024)

WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

CPT only copyright 2023 American Medical Association. ALL rights reserved. CPT is a registered trademark of American Medical Association.

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept".

These materials contain Current Dental Terminology, Fourth Edition (CDT), Copyright © 2023 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must exit from this computer screen.

TexMedConnect and My Account Guides (2024)

FAQs

How do I check the status of my Medicaid claim in Texas? ›

AUTOMATED INQUIRY SYSTEM

Call 800-925-9126, Option 1 to check claim status, client eligibility, benefit limitations, current weekly payment amount, and claim appeals.

Who processes Texas Medicaid claims? ›

Texas Medicaid & Healthcare Partnership (TMHP) processes claims for Medicaid services provided in the traditional, fee-for-service system.

What is the timely filing limit for Texas Medicaid? ›

A claim that is not submitted within 365 days of the date of service will not be considered for payment. If a client is not yet eligible for Medicaid, providers must submit the claim using either 999999999 or 000000000 as the recipient identification number.

How to submit secondary claims to Texas Medicaid? ›

Submitting a secondary claim to Medicaid
  1. Pay the full claim for the service.
  2. Pay a portion of the claim. Submit a claim to UnitedHealthcare Community Plan for payment consideration, include the primary insurance explanation of benefits (EOB)
  3. Not respond within 110 days from the date of service. ...
  4. Deny the claim.
Dec 1, 2022

How long does it take for Texas Medicaid to be approved? ›

Texas Health and Human Services usually will let you know in 45 days or less. If you or your child has a disability that is included on the application, Texas Health and Human Services might take up to 90 days to get back to you with a decision.

Why am I being denied Medicaid in Texas? ›

Most commonly, an applicant is denied for having income and / or assets over Medicaid's limit(s). See state-by-state eligibility criteria. Another common denial factor is actually an approval, but with a Penalty Period due to violating Medicaid's Look-Back Rule.

What are the most common errors when submitting claims? ›

Simple Errors
  • Incorrect patient information. Sex, name, DOB, insurance ID number, etc.
  • Incorrect provider information. Address, name, contact information, etc.
  • Incorrect Insurance provider information. ...
  • Incorrect codes. ...
  • Mismatched medical codes. ...
  • Leaving out codes altogether for procedures or diagnoses.
  • Duplicate Billing.

Do you have to pay back Medicaid in Texas? ›

If you received Medicaid long-term services and supports, the state of Texas has the right to ask for money back from your estate after you die. In some cases, the state may not ask for anything back, and the state will never ask for more money back than it paid for your services.

What are the two types of Medicaid in Texas? ›

In Texas, there are 5 different types of Medicaid:
  • Traditional Medicaid.
  • STAR.
  • STAR Kids.
  • STAR Health.
  • STAR+PLUS.

What is a clean claim? ›

“A clean claim is one that must be submitted with no inconsistencies or other factors, such as insufficient documentation, that would prevent payment.” A clean claim requires numerous elements, and medical bills are turned down if any of these elements are unaccounted, incomprehensible, or inaccurate.

Can Texas Medicaid patients be billed? ›

Balance billing is the practice in which providers bill Medicaid and CHIP eligible members for covered services. A member cannot be billed for charges beyond reimbursement paid under Texas Medicaid for covered services.

What is the allowed amount of a claim? ›

The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.” When a provider bills you for the difference between the provider's charge and the allowed amount.

Do you have to pay if Medicare denies a claim? ›

If Medicare denies payment: You're responsible for paying. However, since a claim was submitted, you can appeal to Medicare. If Medicare does pay: Your provider or supplier will refund any payments you made (not including your copayments or deductibles).

Is Texas Medicaid retroactive? ›

An application for retroactive eligibility must be filed with the Health and Human Services Commission (HHSC); it is not granted automatically. The applicant must request the prior coverage from an HHSC representative and complete the section of the application about medical bills.

Can I use my Texas Medicaid in another state? ›

Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your Medicaid coverage when you're temporarily visiting another state, unless you need emergency health care.

How do I check the status of my Texas benefits case? ›

Log in to your account. Find your case in the 'My cases' section. View the status for each benefit programs for your case.

What is the phone number for Medicaid claims in Texas? ›

Appendix I, Helpful Telephone Numbers
CARE Form System (3618, 3619, and 3652)800-727-5436
Protective and Regulatory Hotline (PRS)800-252-5400
Provider Claims Services512-438-2200
Texas Medicaid and Healthcare Partnership-Long Term Care800-626-4117
Vendor Drug Hotline800-435-4165
7 more rows

How to verify Medicaid coverage online in Texas? ›

1) Go to the tmhp.com. 2) Select Eligibility Quick Check from the Resources drop-down menu. 3) You must complete two of the following fields: Patient Control Number (PCN), also known as the Medicaid number, Date of Birth (DOB), Social Security Number (SSN), or Last Name.

How long does Texas benefits take to review an application? ›

Generally, a state has a 30-day approval period before issuing food stamp benefits but may provide "expedited benefits" in as little as seven days to those who need emergency food or have a qualifying income.

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