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New Provider Type When Billing for Non-LMHA Providers of MH TCM/Rehab

Date: 05/11/21

Texas Health and Human Services (HHS) is currently working with non-Local Mental Health Authority (LMHA) providers of Mental Health Targeted Case Management and Mental Health Rehabilitation (MH TCM/Rehab) to help them enroll in a new provider type similar to the one LMHAs use to deliver MH TCM/Rehab. The new provider type/specialty is identified as “MH Case Management/MH Rehabilitative Services—Non-LMHA” (12/PR) on the provider enrollment application. HHS is coordinating with the Texas Medicaid & Healthcare Partnership (TMHP) to ensure all providers are informed of the change and understand the process for making the transition.

Both existing and new non-LMHA provider types are billable designations and will be recognized as such by Superior HealthPlan.

Please note:

  • The deadline for non-LMHA providers to bill for MH TCM/Rehab services under provider types outside of 12/PR is November 1, 2021.
  • Beginning November 1, 2021, non-LMHA providers will no longer be eligible to receive reimbursement for these services under any other provider type and must bill under the 12/PR provider type.
  • Superior will recognize, accept and adjudicate claims for MH TCM/Rehab services under existing provider types for non-LMHA providers through October 31, 2021.
  • Beginning November 1, 2021, Superior will only accept non-LMHA claims for MH TCM/Rehab services billed under the 12/PR provider type.

For any questions, please contact your local Superior Account Manager.