Texas: Maternal level-of-care reimbursement

Effective Dec. 1, 2021, we will reimburse maternal services for Medicaid members receiving care in your facility that align with the assigned Texas Health and Human Services Commission (HHSC) level-of-care designations.

How to avoid claims denial

  • Your facility will need the required maternal level-of-care designation, which will be verified using data from HHSC. (Hospitals maintained or operated by the state, or an agency of the state, are exempt.)
  • The facility address on the claim submission must match what is on the State Master Provider file

If a hospital does not meet the minimum requirements for any level-of-care designation for maternal services, they will only be eligible for reimbursement for emergency services required to be provided or reimbursed under state or federal law.

Questions?

Call 888-887-9003, from 8 a.m. to 6 p.m. CT, Monday through Friday. 

PCA-1-21-03131-C&S-News