General Category > New!
Texas Medicaid HMO
rajesh_sh:
Kindly clarify the following.
In our process we have some of claims were denied by Texas medicaid HMO (Molina,Superior & community Health plan) when these insurance are actiing as secondary to Medicare as they will cover only Long term care benefits alone.
When we checked with this HMO they said all other services will be covered only by the direct Texas Medicaid.
Please confirm this and also provide us the Policy document link to know more details about this.
PMRNC:
Is the provider Par with this HMO?
macbook:
Molina, Superior and CHC(Community Health Choice) are all managed care plans for Texas Medicaid. Now, if these managed care plans will only cover long term care benefits for this patient, and reverts you to TMHP(Traditional Medicaid) then that's what I would do. To check on eligibility status and more info, go to www.tmhp.com and if you have TMHP user account for your provider then you can log on and find more information there.
If you do not have a TMHP User Account, choose one of the following options:
To create a TMHP User Account and begin the enrollment process to be a new provider in Texas Medicaid or the CSHCN Services Program, click New Username and Enroll.
To create a TMHP User Account and activate an existing Texas Medicaid or CSHCN Services Program provider/vendor account for online use, click New Username and Activate Existing Provider.
Hope this helps.
Also, I agree with Linda, your provider needs to also be a participting provider with the Managed care plans.
ltjen:
In my experience, (billing DME) when a client has an HMO with Medicare primary, Medicare makes the payment then they forward the 20% to TMHP. This is what I see with all equipment when they have Medicare/Medicaid-HMO. I'm sorry but I cannot find the link to verify that info. :-\
rajesh_sh:
Yes Linda,
These providers are par with HMO as well.
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