Texas Medicaid Updates Billing Process for UnitedHealthcare Community Plan
Starting September 1, 2025, direct all billing for Medicaid-covered services and medications, including Medicare wraparound coverage, for Dual Special Needs Plan (D-SNP) members to UnitedHealthcare Community Plan of Texas. These updates are required under Texas House Bill 1 (Article II, HHSC, Rider 32).
Key Updates to Medicaid Billing and Services
- The Texas Health and Human Services Commission (HHSC) will cease managing billing and prior authorizations for Medicaid-covered services.
- Wraparound medications, including over-the-counter drugs, cough and cold remedies, and select prescription vitamins and minerals, will transition from fee-for-service (FFS) to the HHSC-established rate, with Optum Rx® overseeing medication billing.
- Medicaid-covered services will shift from FFS to a managed care billing model, aligned with the HHSC rate.
- Services for Medicaid-only beneficiaries, such as pediatric nursing facility care, provided through FFS, will remain unchanged.
Prior Authorization Details
Certain services and medications require prior authorization. Existing prior authorization requirements will remain unchanged. You can submit prior authorization requests via the UnitedHealthcare Provider Portal.
Easy Steps for Prior Authorization
- Visit UHCprovider.com and click “Log In” at the top-right.
- Sign in with your One Healthcare ID and password.
- New user? Register for a One Healthcare ID on the provider registration page.
- Go to “Prior Authorizations” in the menu.
- In the tool, find “Start a New Request” and click it.
- Enter the needed info and submit.
Learn more about using the UnitedHealthcare Provider Portal.
Helpful Resources
- Check the list of procedure codes needing prior authorization.
- See all Rider 32 procedure codes and the detailed list.
Questions?
Contact your Provider Advocate or call UnitedHealthcare Community Plan of Texas at 888-887-9003, Monday toFriday, at 8 a.m. to 6 p.m. CT.
