New Texas Medicaid & Healthcare Partnership (TMHP) Contracts

Date: October 10, 2023

Attention: All Providers

Effective date: September 1, 2023

Call to action: The purpose of this communication is to inform providers that effective September 1, 2023 two new Texas Medicaid and Healthcare Partnership (TMHP) contracts went live:

• Accenture State Healthcare Services LLC (Accenture) is now the TMHP Business Operations and Business Integration (BusOps) vendor.
  • The TMHP BusOps vendor acts as the project management office across the TMHP vendors and will manage the overall Medicaid ecosystem, including support services such as project management, prior authorizations, and medical necessity determinations, call center, Medicaid enrollment outreach, and mailroom/document intake services. 
• Deloitte Consulting LLP is now the TMHP Application Maintenance and Development (AMD) vendor.
  • The TMHP AMD vendor is responsible for supporting and maintaining Texas Medicaid information technology applications such as:
    • Provider Enrollment and Management System
    • Electronic Visit Verification aggregator and portal,
    • Prior Authorization on the Portal; and,
    • The Medicaid Client Portal.

As a reminder, TMHP handles fee-for-service claims processing, provider enrollment, and a wide range of other functions on behalf of the Health and Human Services Commission (HHSC).

Future Contract information:

• In December 2024 a third TMHP contract for Claims Processing and Adjudication and Financial Services (Claims) with Conduent State Healthcare, LLC (Conduent) will be implemented.
  • The TMHP Claims vendor will perform fee-for-service claim processing and fiscal agent responsibilities such as claim payment and recovery of overpayments.
  • HHSC plans to implement the out-patient prospective payment system methodology for out-patient services with the Enhanced Ambulatory Patient Group as part of Conduent’s go-live in December 2024.

TMHP claims processing will continue as-is until the new TMHP Claims contract is fully implemented in December 2024.

How this impacts providers: HHSC has identified no impacts to stakeholders as a result of the September 1, 2023 transition.

Next step for Providers: TCHP and HHSC will provide more information about this transition along with any next steps that you need to take as the transition progresses. Sign up for GovDelivery to receive email updates and check tmhp.com regularly. For updates from TCHP, go to www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.