June 2026 TMHP Update: Key Changes for Newborn Services

May 13, 2026

1 minute

June 2026 TMHP Update: Key Changes for Newborn Services

Effective June 01, 2026, the Texas Medicaid and Healthcare Partnership (TMHP) will update section 9.2.47, "Newborn Services," in the Texas Medicaid Provider Procedures Manual, specifically the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook. The update removes the reference to procedure code 99360, which is not a covered benefit under Texas Medicaid.

Providers are advised to review their billing workflows accordingly to ensure that this procedure code is not in use, as its presence may result in claim issues.

Providers associated with Medicaid Managed Care Organizations (MCOs) should note that administrative procedures, including prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional fee-for-service Medicaid and can vary from one MCO to another. Providers are encouraged to contact the member's specific MCO directly for further clarification.

For additional information, providers may contact the TMHP Contact Center at 800-925-9126.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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