TMPPM 2011 > Volume 1, General Information > Welcome: 2011 Texas Medicaid Provider Procedures Manual


Welcome: 2011 Texas Medicaid Provider Procedures Manual

This manual is a comprehensive guide for Texas Medicaid providers. It contains information about Texas Medicaid benefits, policies, and procedures. It also includes information about Texas Health Steps (THSteps), the Children's Services Program and managed care programs, including Primary Care Case Management (PCCM).

Texas Medicaid policy published in this manual was implemented on or before January 1, 2011. Policy updates effective after January 2, 2011, are published bimonthly in the Texas Medicaid Bulletin.

All Texas Medicaid policy updates that are published bimonthly in the Texas Medicaid Bulletin supplement this manual and update the policy it contains.

This manual and copies of the Texas Medicaid Bulletin are available on the TMHP website at

The 2011 Texas Medicaid Provider Procedures Manual (TMPPM) is divided into two volumes as follows:

Volume I: General Information

Volume 1 applies to all health-care providers who are enrolled in Texas Medicaid and provide services to Texas Medicaid clients. The sections in Volume 1 include general information for enrolling in the program, receiving appropriate reimbursement, and claim submissions and appeals for services rendered.



TMHP Telephone and Address Guide

Section 1. Provider Enrollment and Responsibilities

Section 2. Texas Medicaid Reimbursement

Section 3. TMHP Electronic Data Interchange (EDI)

Section 4. Client Eligibility

Section 5. Prior Authorization

Section 6. Claims Filing

Section 7. Appeals

Section 8. Managed Care

Appendix A: State and Federal Offices Communications Guide

Appendix B: Vendor Drug Program

Appendix C: HIV/AIDS

Appendix D: Medical Transportation

Appendix E: Acronym Dictionary

Index (for Volume 1 and all handbooks)

Volume 2: Provider Handbooks

Volume 2 includes 11 handbooks. Each handbook covers Medicaid policies, procedures, and claims filing requirements for specific products or services. Volume 2 includes the following handbooks:

Ambulance Services Handbook

Behavioral Health, Rehabilitation, and Case Management Services Handbook

Children's Services Handbook

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook

Gynecological and Reproductive Health, Obstetrics, and Family Planning Services Handbook

Hospital Services Handbook

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook

Nursing and Therapy Services Handbook

Outpatient Services Handbook

Radiology and Laboratory Services Handbook

Vision and Hearing Services Handbook

Texas Medicaid & Healthcare Partnership
CPT only copyright 2010 American Medical Association. All rights reserved.