This training has been designed to give you the most up-to-date information as of the publication date. It is your responsibility to regularly review the current Texas Medicaid Provider Procedures Manual (TMPPM), the current CSHCN Services Program Provider Manual, and all updated information as it is published on the Texas Medicaid & Healthcare Partnership (TMHP) website at www.tmhp.com.

You have the opportunity to provide feedback regarding your online training experience. We value your opinions and ask that you complete a brief survey upon the conclusion of this training.

The purpose of this training is to educate, assist, and support Medicaid providers who submit prior authorization requests and Children with Special Health Care Needs (CSHCN) Services Program providers who submit authorization and prior authorization requests.

When it comes to prior authorizations, timing is everything. In this webinar, the following topics are discussed:

  • In the Medicaid fee-for-service (FFS) section, we’ll identify general prior authorization guidelines and explain how retroactive eligibility can impact prior authorizations.
  • In the CSHCN Services Program section, we’ll identify authorization and prior authorization guidelines that are unique to the CSHCN Services Program.
  • Next, we have the PA Criteria section, which highlights the prior authorization criteria for FFS, CSHCN Services Program, and retroactive eligibility.
  • Submission Methods will list the different methods for submitting prior authorization requests and submission best practices.
  • PA on the Portal is the recommended submission method for prior authorization requests. In this section, we’ll show you how to access the portal and where you can view your requests that are in Pending Provider Response status.
  • Finally, we’ll end the webinar with a list of the takeaways from today’s presentation, as well as a Q&A session.