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New TMHP Contracts

Date: 10/23/23

Texas Medicaid and Healthcare Partnership (TMHP) handles fee-for-service claims processing, provider enrollment, and a wide range of other functions on behalf of the Texas Health and Human Service Commission (HHSC). Effective September 1, 2023, two new 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 Texas Medicaid ecosystem which includes support services such as:
    • Project management
    • Prior authorizations
    • Medical necessity determinations
    • Call center/Medicaid enrollment outreach
    • 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

HHSC has identified no impacts to stakeholders due to this transition.

Please note, 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 claims processing and fiscal agent responsibilities, such as claims payment and recovery of overpayments.
    • HHSC plans to apply the out-patient prospective payment system methodology for out-patient services with the Enhanced Ambulatory Patient Group, as part of Conduent’s implementation.
  • TMHP claims processing will continue as-is until the new TMHP claims contract is fully implemented.

HHSC will provide more information and any steps you need to take throughout this transition period. To stay updated, subscribe to Email and Text updated from HHSC for updates and check TMHP website regularly.