Medicaid PCNs Starting With “9”—Prior Authorization and Acute Care Claims Submissions
AI Summary
Texas Medicaid patients with PCNs starting with '9' are showing as ineligible in TMHP systems, causing prior authorization and claims submission failures. Providers must fax prior auth requests instead of using the online portal and wait for new PCNs before submitting fee-for-service claims.
Action Required
Immediately: For Texas Medicaid patients with PCNs starting with '9', billing staff must verify eligibility through Medicaid Client Portal before processing. Prior auth team must fax requests to appropriate TMHP numbers instead of using PA Portal. Hold fee-for-service claims until patients receive new PCNs. For managed care claims, submit directly to MCO without waiting for new PCN. Monitor TMHP website 'Recent News' section daily for resolution updates.
Plan Types
Medicaid
States
TX
Specialties
all-specialties