Background:

As a follow-up to the MCO Notices released March 25, 2021, and April 26, 2021, HHSC reminds MCOs that non-local mental health authority (non-LMHA) providers must bill mental health targeted case management and mental health rehabilitation (MH TCM/MHR) services exclusively under the 12/PR provider type for claims with dates of service on or after November 1, 2021. MCOs must continue to allow non-LMHA providers to bill for MH TCM/MHR services under existing provider types for claims with dates of service through October 31, 2021.  

Providers have been notified of this deadline through the August 25, 2021, Texas Medicaid & Healthcare Partnership (TMHP) provider notice, “October 31, 2021 Enrollment and Credentialing Deadline for Non-LMHA Providers of Mental Health Targeted Case Management and Rehabilitative Services.”  

Action:

  • For claims with dates of service on or before October 31, 2021, MCOs must recognize, accept, and adjudicate non-LMHA provider MH TCM/Rehab claims billed under existing provider types.
  • For claims with dates of service on or after November 1, 2021, MCOs must only accept non-LMHA provider MH TCM/MHR claims billed under the 12/PR provider type.
  • MCOs must notify non-LMHAs of their intent to enforce the 12/PR provider type starting November 1, 2021.

Resources:

MCO Notice – 4.26.21: Additional Guidance for Non-LMHA Providers of MH TCM/Rehab (Attached)

MCO Notice – 3.25.21 New Provider Type for Non-LMHA Providers of MH TCM/Rehab (Attached)

TMHP Provider notice: October 31, 2021 Enrollment and Credentialing Deadline for Non-LMHA Providers of Mental Health Targeted Case Management and Rehabilitative Service

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