Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ...
Background: The Texas Medicaid & Healthcare Partnership’s (TMHP) Provider Enrollment and Management System (PEMS) is coming soon. Provider enrollment functions will be available through PEMS, and providers must use the new system to enroll in Texas Medicaid. The...
The Provider Enrollment and Management System (PEMS) fully deployed on December 13, 2021. The system introduced new business rules for enrollment in Texas Medicaid. Prior to the PEMS implementation, the provider billing effective date could be either the Medicare...
Community First Health Plans has partnered with Option Care Women’s Health to assist our high-risk obstetrical Members. Option Care Women’s Health provides quality high-risk obstetrical care delivered by specialized nurses for management of the following:...
As of September 10, 2024, the following 2024-25 COVID-19 vaccines are a payable pharmacy benefit for Medicaid and CHIP Members. National Drug Codes (NDC)Vaccine Label Name 80777011001SPIKEVAX 2024-25 (12Y UP)80777011093SPIKEVAX 2024-25 (12Y UP)80777011096SPIKEVAX...
Attention Community First Providers: You may begin collecting CHIP COVID-19 co-pays on October 1, 2024. During the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for COVID-19 vaccines, testing, and treatment for...
