Provider News

Medicaid—Anesthesia Reimbursement Benefit Language Clarified for Texas Medicaid, Effective 05/01/2018

Wednesday, Apriil 4, 2018

Effective for dates of service on/after May 1, 2018, anesthesia reimbursement benefit language will be clarified for Texas Medicaid.
Anesthesia Reimbursement Benefit Language Clarifications
The following will be clarified in the Texas Medicaid Anesthesia Reimbursement benefit policy:
  • An anesthesia practitioner is defined as an anesthesiologist who performs the anesthesia service alone or medically directs a certified registered nurse anesthetist (CRNA), anesthesiologist assistants (AA) or other qualified professional.
  • When a single claim per client is billed by the anesthesiologist for medically directing anesthesia services of an anesthesia procedure provided by one CRNA, AA or qualified professional, the QY and U1 modifier combination must be billed together when the CRNA, AA or qualified professional is part of a clinic or group.
  • Modifiers QZ and U1 must be submitted when a CRNA has personally performed the anesthesia services, is not medically directed by the anesthesiologist and is directed by the physician. 
  • Epidural and subarachnoid infusion (not including labor and delivery): 
    • Epidural and subarachnoid infusion for pain management is payable for acute, chronic and postoperative pain management; 
    • Procedure code 01996 is payable to CRNAs and physicians and is limited to once per day and will be denied when billed on the same day as a surgical/anesthesia procedure; and 
    • Procedure code 01996 billed longer than 30 days requires medical necessity documentation. Cancer diagnoses are excluded from the 30-day limitation.

FirstCare Awarded Recertification of its NCQA Accredited Status

Monday, March 19, 2018

We are pleased to announce that the National Committee for Quality Assurance (NCQA) recently awarded full, three-year Accredited status again to FirstCare’s HMO lines of business (i.e., Commercial, Medicaid, Medicare, and Marketplace). Effective 02/16/2018, this accreditation runs through 02/16/2021. As with our original accreditation in 2015. we pursued this accreditation because of our commitment to the highest quality health care for our more than 170,000 members throughout 108 counties in North, West and Central Texas.
NCQA Accreditation recognizes FirstCare’s ongoing commitment to providing quality health care to our members as health plans earning this accreditation are shown to outperform non-accredited health plans across a wide range of measures, including clinical quality and member satisfaction.
Our accreditation status was awarded after rigorous evaluation by NCQA of all aspects of our plan, including preventive health services, member satisfaction, physician credentialing and quality improvement.
If you have any questions, please contact your FirstCare Provider Relations Representative at:
Region Phone Number Email
Abilene 325-670-3882
Amarillo 806-467-3200

Lubbock, Waco and
all other areas




Medicaid/CHIP—Upcoming Provider Revalidation Webinar

Monday, March 12, 2018

On Thursday, March 22, 2018, TMHP will conduct a live webinar designed to offer a high-level introduction to the revalidation process using Provider Enrollment on the Portal.
The Provider Revalidation webinar will introduce the new streamlined electronic Revalidation application, instructional site hyperlinks, and the message dashboard, as well as provide a high-level description of the revalidation process in PEP.
Topics covered in the webinar include:
  • Identifying the differences between revalidation and re-enrollment
  • Understanding the Affordable Care Act screening requirements, risk levels, deadlines and application fees
  • Locating notifications on the My Account message dashboard
  • Navigating through the revalidation process in PEP
  • Using the View Existing Transactions page
  • Understanding the difference between revalidation in PEP and the six-month verification process in the Provider Information Management System
Click the following link to register for the webinar:  
For more information, call the TMHP Contact Center at 1-800-925-9126.

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