TX Medicaid Preferred Setup


If your provider is not in a group with Texas Medicaid or has only one TPI (i e does not participate in TSTEPS or other benefit plans) then you do not need these instructions. Just make sure the attestation data for all your TPIs are the same. Pay close attention to Zip Codes and Taxonomy Codes. Then match them in Medisoft.

Please note that if the majority of your Acute and TSTEPS claims are being paid leave your setup alone. This is not the only working way to setup Medisoft with InterfaceEDI for TX Medicaid.

This information currently applies to Insurance Carrier setups with the EMC Payer Number of 86916 or if you are send claims directly to TMHP only.

Background,
In the past it was necessary to create separate providers in Medisoft for each Acute Care and TSTEPS TPI.

Currently,
With the creation of the NPI, TX Medicaid has requested that a practice do the following

1) match the Group Practice NPI with their Group TPI, and their Individual TPI with the Individual NPI
2) match the Group Practice NPI with their TSTEPS TPI

If your provider is in a Group with Texas Medicaid and also provides services for the TSTEPS program, the following is the preferred setup if you are using InterfaceEDI 2.3.0.188 or above.

At www.tmhp.com
For Acute Care attest your Group NPI and Group Taxonomy Code to Group TPI, Attest your Individual NPI and Taxonomy to your Individual TPI
For TSTEPS, attest your Group NPI and Group Taxonomy Code to the TSTEPS TPI

In Medisoft, Use only one provider in Medisoft. Create an insurance company for Acute Care and  an insurance company for TSTEPS
Place your Group NPI in a Provider Class under National Provider ID
Place your Group Taxonomy Code under the Class Description
Place your Individual NPI in the provider's National Provider ID
Place your individual Taxonomy code in the Taxonomy Code field.
for the TSTEPS insurance company, place EP1 in the Plan Name field, this is required by TMHP for paper claims
for the Acute Care insurance company, leave the Plan Name blank.