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Texas Medicaid HMO

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macbook:
Rajesh_sh,

 I was able to come across that as well with Medicare. Although in my case, it did a cross over  directly to TMHP traditional even if my patient stated secondary as a managed care plan or if the TMHP web portal stated it as well.

Now, the best thing for this is to verify benefits from the get go.  With most IVR's they would state that the pt has Managed Care Plan. In this light, you will have to bill Traditional TMHP.

LTC is a benefit (like Star Plus LTC) that is chosen by the patient if they chose to include it under the MCO's plan benefit. With the new rule of TMHP since Jan 2012 not covering for the amount greater than the allowable amount of Medicaid, it will have a denial code of 00238 or the like. For a more detailed explanation, please go to their website for bulletin updates. Or call the MCO's or TMHP directly for clarification.

Hope this helps.

Thanks

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