Texas Medicaid to Implement Second Quarter NCCI Updates Effective April 1, 2026

Apr 03, 2026

1 minute

Texas Medicaid to Implement Second Quarter NCCI Updates Effective April 1, 2026

Beginning April 1, 2026, TMHP will apply the second-quarter NCCI updates to Texas Medicaid and the Children with Special Health Care Needs Services Program.

Providers can review the updated Medicaid NCCI guidance, coding edits, and procedure relationships on the CMS Medicaid NCCI webpage. Since these rules may change, it is important for providers to review the CMS page regularly for the latest information. TMHP also includes a link to that page under the Rate and Code Updates section on tmhp.com.

For support, providers may contact the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.

Note: TMHP also reminds providers that Medicaid managed care organizations in Texas must continue to provide all medically necessary covered services to enrolled members. However, the administrative side of the process may differ. Prior authorizations, referrals, precertification, and claim submission steps may vary from traditional Medicaid and may not be the same across all MCOs. Providers should confirm the exact process with the member’s health plan before proceeding.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

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.

Eligibility Verification

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.

Revenue Cycle Management

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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