Verifying Eligibility in TMHP

TMHP is Texas' Medicaid Portal. Admins will access TMHP to verify that clients are active in a Medicaid plan that your clinic accepts. Eligibility checks need to be completed while processing the initial intake as well as the 1st of every month.

Jessica Lopez
17 steps
2 minutes

Tmhp

Eligibility checks will need to be completed while processing the initial intake as well as the 1st of every month.

Go to <https://www.tmhp.com/>

Click "I Accept"

Click "My Account"

Click "Medicaid Client Portal for Providers" Note: For Superior clients please click the top link "TexMedConnect"

Click "I Agree"

Enter the Client's information to search for them in TMHP's database. Note: TMHP sometimes has incorrect information so you'll need to try different fields to find the Client.

Click "Search"

Click "Yes" if this is the correct Client

Click "Submit" to view the Client's Eligibility for the current month.

This is the "Cards" section of the Medicaid Client Portal. Verify that the Current Medicaid Status is Active. It will say Inactive in red if the Client is not eligible for services. Verify the Medicaid ID #.

Click Medicaid Benefits

Scroll down to Medicaid Health Plans to see which Medicaid plan (MCO) the Client is enrolled in. Verify that it is a plan that your clinic or MPA accepts

Tip! Some Clients will believe they have Medicaid but will show as Inactive if they have CHIP. However, CHIP does not cover our services therefore it will show Inactive. Most people who have Medicaid in Texas get their coverage through the STAR managed care program. STAR covers low-income children, pregnant women and families. When clients are first enrolled in Medicaid they'll be on the Traditional plan. They will need to select a Medicaid plan. If they don't, Medicaid will enroll them into a plan automatically and it might be a plan that your clinic doesn't accept. Star+Plus is for adults who have disabilities or are age 65 or older.

Tip! Copy and Paste information exactly how it is listed in TMHP. Any discrepancies from exactly how TMHP has it spelled or entered will cause claims to be denied or rejected.

In the Cards (Eligibility) tab you'll see the client's Name, Date of Birth, and Address as TMHP has it in their records.

Scroll Down to the Medical Coverage section to view the Plan Begin Date

The Primary Care Provider's Information is listed under Medical Coverage. This is entered on the Client's Dashboard later.

The Client's Dentist's Information is listed under Dental Coverage. This is entered on the Client's Dashboard later.

Under the Medicaid Benefits tab, you'll see alerts if a Checkup is due for the PCM or Dentist. You'll create flags for this in the client's dashboard later.