If you are applying for an agreement regarding a healthcare intermediary service provider, send a copy of the TMHP notification letter: To obtain reimbursement for Medicaid services, eligible healthcare providers must be approved for registration of HHSC and enter into a written agreement with HHSC. Claimant registration is described in detail in Section 2 of this training. TMHP publishes the Texas Medicaid Provider Procedures Manual, a comprehensive guide for Texas Medicaid providers. It contains information about Texas Medicaid benefits, policies, and procedures. In the manual is the Children`s Health Services Handbook, which contains specific information for children. During this training, you will see references to the manual. As a claims manager, TMHP processes claims for Medicaid services provided in the traditional Fee for Service system. TMHP does not process any claims for services provided by Medicaid Managed Care Organizations (MCOs), but collects meeting data from MCOs to assess the quality and utilization of management care services. The National Children`s Health Insurance Program (CHIP) offers health insurance for children in families who earn too much to qualify for Medicaid but can`t afford private health insurance.
Due to changes in family income status, many children switch from Medicaid to CHIP or vice versa. Unlike Medicaid, CHIP does not offer retroactive coverage. Under Texas law, the Department of State Health Services (DSHS) must help a family whose child loses Medicaid entitlement to switch to CHIP without interruption.