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News update

Sep 04, 2025

Update: Prior Authorization for DMEPOS Replacements Being Expedited Following Central Texas Floods

This notice revises the July 28, 2025, tmhp.com article titled “Prior Authorization Requests for DMEPOS Replacements Due to the Central Texas Floods Being Expedited.” TMHP is expediting processing for new prior authorizations and recertifications to replace flood-impacted DMEPOS and is waiving submission time frames and documentation requirements for those new replacement requests.

Important Updates

TMHP has lifted the requirement that clients be permanent residents of a disaster-designated county. Expedited prior authorization is available statewide through September 29, 2025, for Texas Medicaid and CSHCN clients who were affected by the 2025 Texas flooding in a declared disaster county. To qualify for the expedited process, providers must state that the request is due to the 2025 Central Texas floods and explain why the DMEPOS must be replaced.

Requirements for Expedited Prior Authorization

In the PA, state the need is due to the 2025 Central Texas floods and explain why replacement is required.
Keep documentation that DMEPOS were lost, destroyed, irreparably damaged, or unusable due to flooding.
Note: Services may be subject to retrospective medical-necessity review.
For help, call 800-925-9126 (TMHP Contact Center) or 800-568-2413 (TMHP-CSHCN).

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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.

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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.

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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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