Provider Information

Texas Medicaid and CHIP provider resources include information on provider enrollment and re-enrollment, rate analysis, the CHIP Perinatal program, physician-administered drugs and communications resources.

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 STAR, STAR+PLUS, STAR Health, STAR Kids or managed care dental complaint or inquiry by using the Online Question or Complaint Form or by emailing HPM_Complaints@hhsc.state.tx.us.

You can see the complaint process by viewing the Health Plan Management Complaint Process flow chart (PDF). An accessible version of the steps in the complaint process (PDF) is also available.

Providers also may mail STAR, STAR+PLUS, STAR Health, STAR Kids 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