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TMHP handles fee for service claims processing, provider enrollment, and a wide range of other functions on behalf of the Texas Health and Human Services Commission (HHSC). HHSC is in the process of implementing new contracts for TMHP.
On Sept. 1, 2023, two new TMHP contracts went live:
- Accenture State Healthcare Services LLC (Accenture) is now the TMHP Business Operations and Business Integration (BusOps) vendor.
- The TMHP BusOps vendor acts as the project management office across the TMHP vendors and will manage the overall Medicaid ecosystem, including support services such as project management, prior authorizations, and medical necessity determinations, call center, Medicaid enrollment outreach, and mailroom/document intake services.
- Deloitte Consulting LLP is now the TMHP Application Maintenance and Development (AMD) vendor.
- The TMHP AMD vendor is responsible for supporting and maintaining Texas Medicaid information technology applications such as:
- Provider Enrollment and Management System
- Electronic Visit Verification aggregator and portal,
- Prior Authorization on the Portal; and,
- The Medicaid Client Portal.
HHSC has identified no impacts to stakeholders as a result of the Sept. 1, 2023 transition.
In December 2024 a third TMHP contract for Claims Processing and Adjudication and Financial Services (Claims) with Conduent State Healthcare, LLC(Conduent) will be implemented.
- The TMHP Claims vendor will perform fee-for-service claim processing and fiscal agent responsibilities such as claim payment and recovery of overpayments.
- HHSC plans to implement the out-patient prospective payment system methodology for out-patient services with the Enhanced Ambulatory Patient Group as part of Conduent?s go-live in December 2024.
TMHP claims processing will continue as-is until the new TMHP Claims contract is fully implemented in December 2024.
HHSC will provide more information about this transition and any steps you need to take as the transition progresses. Sign up for GovDelivery to receive email updates and check tmhp.com regularly.
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