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Texas Health Steps
How It Works
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Checkups and a Whole Lot More!
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- Qualified medical and dental providers enroll in Medicaid and indicate
on the enrollment form that they will be providing Texas Health Steps
services.
- A nine-character Texas Provider Identifier (TPI) is issued to the
provider by the Claims Administrator (Texas Medicaid & Healthcare
Partnership). This identifier is very important since it is used when
filing claims for reimbursement for providing Texas Health Steps services.
- Locally field-based Texas Medicaid & Healthcare Partnership (TMHP)
Medicaid Provider Relations Representatives are available to assist
and train Medicaid providers. These Provider Relations Representatives
provide education and training on claims submission for new and existing
Medicaid providers. Technical support and training also are provided
for TDHconnect software users. To find how and where to request this
type of assistance and training, visit the TMHP
Regional Support web page. In addition regionally-based Department
of State Health Services (DSHS) Texas Health Steps (THSteps) Provider
Relations Representatives are available to respond to Medicaid providers'
questions and problems. To find how and where you may request this type
of assistance, visit the DSHS
THSteps Regional web page.
- Texas Health Steps Outreach and Informing staff contact newly enrolled
Texas Health Steps recipients to inform them of the services to which
they are entitled; to encourage them to use the Texas Health Steps preventive
medical and dental check-up services; to provide them with a list of
all Texas Health Steps providers in their area, and; to assist them
in setting an appointment for a medical and/or dental check-up.
- At the time of their appointment, recipients present their Medicaid
identification form (Form #3087) to their provider and receive their
medical and dental check-ups from and establish a medical or dental
home with their Texas Health Steps provider. Should additional acute
care be needed as a result of the check-up, these services are also
provided and providers receive reimbursement for providing them.
- The Provider submits an electronic or paper claim form to the Claims
Administrator for reimbursement. Deadlines for submitting claims: 95
days for in-state providers and 365 days for out-of-state providers.
- The Provider receives reimbursement from the Claims Administrator.
NOTE: This is brief summary of the process. For more details and
the required enrollment and reimbursement forms and how to complete them,
please visit the current Claims Administrator, the TMHP
website and refer to the
Texas Medicaid Provider Procedures Manual.
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