Contacts for Clients

Questions about Medicaid Managed Care

Call the Medicaid client hotline at 800-252-8263 or visit the Managed Care page on our website. To apply for benefits, visit YourTexasBenefits.com.

Questions about Traditional Medicaid

Call Center General Inquiries Line at 800-925-9126 or visit the Contact Center website (link is external).

Community Resources

No matter where you live in Texas, you can dial 2-1-1 or 877-541-7905 to find information about resources in your local community. Whether you need help finding food or housing, child care, crisis counseling or substance abuse treatment, 1 number is all you need to know.

Client Complaint Resolution

If you have a complaint, please call your health plan to tell them about your problem.  A member services advocate can help you file a complaint. You can find a list of health plans here. Most of the time, they can help you right away or at the most within a few days.

Children’s Health Insurance Program (CHIP) members

If you are not satisfied with the answer to your complaint, you can also complain to the Texas Department of Insurance by calling toll-free 800-252-3439. If you would like to make your request online or in writing, please send it to the addresses listed here.

Medicaid members

Once you have gone through the health plan complaint process, you can complain to the Texas Health and Human Services (HHS) Office of the Ombudsman by calling toll-free 866-566-8989. If you would like to make your complaint online or in writing, please send it to the addresses listed here.

Members also may file a:

You can see the complaint process by viewing this flow chart (PDF). An accessible version of the steps in the complaint process (DOC)  also is available.

Members may mail STAR, STAR+PLUS, STAR Health or children's Medicaid dental services complaint or inquiry to:

Texas Health and Human Services Commission
Medicaid/CHIP Health Plan Management
Mail Code H-320
P.O. Box 85200
4900 N. Lamar
Austin, Texas 78708-5200

Civil Rights issues

Call the Texas Health and Human Services Civil Rights Office if you need to talk to someone about concerns of discrimination or would like to file a discrimination complaint.

Civil Rights Office

Texas Health and Human Services Commission
701 W. 51st St.
MC W206
Austin, Texas 78751
888-388-6332 or 512-438-4313
TTY toll-free: 877-432-7232
HHSCivilRightsOffice@hhsc.state.tx.us

Texas Health and Human Services Commission (HHSC) Headquarters

Texas Health and Human Services Commission
Brown-Heatly Building
4900 N. Lamar Blvd.
Austin, TX 78751-2316
Phone: 512-424-6500
Media calls: 512-424-6951

Report Waste, Fraud, or Abuse

You can report suspected fraud, waste, or abuse in Texas HHS programs to the Office of Inspector General by filling out an online form or by calling 800-436-6184. You also may make a report to the Texas State Auditor's Office by calling 800-TX-AUDIT.

Contacts for Providers

Claims Administration and Provider Enrollment

Texas Medicaid & Healthcare Partnership (TMHP)  is the claims administrator for Texas Medicaid.

Technical Support for Filing Claims: 888-863-3638

Filing Claims for Managed Care Services

Claims for services administered by a medical or dental plan must be submitted to the plan. Providers may submit managed care claims by the following:

  • Submit acute, long term services, or dental claims directly to the appropriate medical or dental plan using the methods established by the plan.
  • Submit acute care or dental claims electronically to TMHP for routing to the appropriate medical or dental plan.

Provider Complaints and Appeals

Fee-For-Service

Medicaid fee-for-service providers must exhaust the administrative and medical appeals provider resolution process with the HHS claims administrator contractor before filing an appeal or complaint with HHSC. Written appeals and complaints may be sent to HHSC at:

Texas Health and Human Services Commission
HHSC Claims Administrator Contract Management
P.O. Box 204077
Mail Code 91-X
Austin, Texas 78720-4077

Medicaid Managed Care

Medicaid managed care providers must exhaust the complaints or grievance process with their managed care medical or dental plan before filing a complaint with HHSC. If after completing this process, the provider believes they did not receive full due process from the managed care medical or dental plan, they may file a:

You can see the complaint process by viewing this flow chart (PDF). An accessible version of the steps in the complaint process (DOC) is also available.

Providers also may mail STAR, STAR+PLUS, STAR Health or children's Medicaid dental services complaint or inquiry to:

Texas Health and Human Services Commission
Medicaid/CHIP
Health Plan Management
Mail Code H-320
P.O. Box 85200
4900 N. Lamar
Austin, Texas 78708-5200

Providers can submit appeals directly to the medical or dental plan that administers the clients' managed care benefits. Claims that originally were submitted to TMHP for routing to the appropriate medical or dental plan can be appealed to TMHP using TexMedConnect or EDI. The appeals will be routed to the appropriate entity for processing.

For additional information see Texas Administrative Code, 1 TAC 354.

CHIP

CHIP call center: 877-543-7669 or 800-647-6558

CHIP Processing Center:
Texas Health and Human Services Commission
P.O. Box 149024
Austin, TX 78714-9024