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Provider FAQ

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Children with Special Health Care Needs (CSHCN) Services Program logo

Q. Why should I become a Children with Special Health Care Needs (CSHCN) Services Program Provider?

Q. What types of providers does CSHCN Services Program need?

Q. Is the CSHCN Services Program a subdivision of Medicaid?

Q. I am enrolled as a Medicaid provider. Does that mean I am also enrolled in the CSHCN Services Program?

Q. I am a Federally Qualified Health Center (FQHC) enrolled in Medicaid. Does your program enroll FQHC’s?

Q. Will becoming a provider with the CSHCN Services Program overrun my office with work?

Q. If I have questions about the enrollment process or if I need help with the online enrollment, where can I call?

Q. I am an enrolled provider in the CSHCN Services Program, and I have difficulty getting my claims paid. How can I make sure that my claims are paid and are not denied?

Q. Who can I call if I have concerns about how my claims are processed?

Q. I enrolled as a provider in the CSHCN Services Program, but my claims are rejected with the message “01140--Unable to assign program/benefit. Please re-file claim with corrected client/provider information.” What does this mean?

Q. How can I determine specific reimbursement rates for my services?


Q. Why should I become a CSHCN Services Program Provider?

A. There are more than 2,500 children currently enrolled in our program across the state. By enrolling as a provider in the CSHCN Services Program, you will be helping children in your area receive the care they need. You may have already provided services to some of our clients, but were unable to obtain payment for your services because you were not enrolled in our program. 

Q. What types of providers does CSHCN Services Program need?

A. Our Program needs all types of providers. Children with special needs often require secondary and tertiary care in addition to their primary care. The Program covers most medical services except for obstetrics, infertility, and family-planning.

If you are a provider of health services or are a medical facility, we need you. The Texas Medicaid and Healthcare Partnership (TMHP), the company who administers the enrollment and payment of providers in our program, has a webpage that explains how to enroll as a provider in our program.

Q. Is the CSHCN Services Program a subdivision of Medicaid?

A. No. The CSHCN Services Program is a separate program from Medicaid and has separate funding sources. Although the services covered and the reimbursement rates of the two programs are very similar, the eligibility requirements and application processes are quite different.

Q. I am enrolled as a Medicaid provider. Does that mean I am also enrolled in the CSHCN Services Program?

A. No. The CSHCN Services Program requires a separate application, a separate signed agreement, and a separate Texas Provider Identification (TPI) number. Online enrollment is available. Go to the Provider Enrollment web page for more information on how to enroll.

Q. I am a Federally Qualified Health Center (FQHC) enrolled in Medicaid. Does your program enroll FQHC’s?

A. Yes, but the CSHCN Services Program does not enroll FQHC’s or Rural Health Clinics (RHC’s) as facilities, like Medicaid does. Individual providers at the FQHC or RHC have to enroll as a group with our program. Another difference between our program and Medicaid is that we reimburse on a fee-for-service basis and do not pay encounter rates. For more information, you can listen to a five-minute audio recording on this topic at Radio TMHP.

Q. Will becoming a provider with the CSHCN Services Program overrun my office with work?

A. No. The CSHCN Services Program only has about 2,500 clients across Texas. This will probably only result in a small number of additional clients for you.

Q. If I have questions about the enrollment process, or if I need help with the online enrollment, where can I call?

A. You can contact the Provider Enrollment Department at TMHP at 1-800-925-9126 for questions specifically about enrollment. For more general questions, call the TMHP Contact Center at 1-800-568-2413. You can also go to the TMHP website and select the “providers” link at the top of the page.

Q. I am an enrolled provider in the CSHCN Services Program, and I have difficulty getting my claims paid. How can I make sure that my claims are paid and are not denied?

A. Information about how to file claims is available in the CSHCN Services Program Provider Manual. The manual is updated monthly. In addition, TMHP offers online training, face-to-face workshops, and individual in-service programs in all areas of the state about authorizations, claims filing, reimbursements, and how to file appeals. To find out more, go to the Provider Education Homepage. updated 2/6/2012

Q. Who can I call if I have concerns about how my claims are processed?

A. You can call the TMHP Helpline at 1-800-568-2413 when you have concerns about how your claims have been processed. Sometimes all you need to do is to resubmit a corrected claim. However, if you are still dissatisfied with how a resubmitted claim has been processed, you can use our program’s appeals process. Details about the appeals system are in Chapter 7 of the 2010 CSHCN Services Program Provider Manual, and will soon be available in the CSHCN Services Program online training. To find out more, go to the Provider Education Homepage.

Q. I enrolled as a provider in the CSHCN Services Program, but my claims are rejected with the message “01140--Unable to assign program/benefit. Please re-file claim with corrected client/provider information.” What does this mean?

A. It probably means that you filed the claim with your Medicaid TPI instead of your TPI for the CSHCN Services Program. File an appeal with the corrected information, and, if the claim is still denied, request an administrative review. For more information about the appeal process, refer to Chapter 7 of the 2010 CSHCN Services Program Provider Manual.

Q. How can I determine specific reimbursement rates for my services?

A. You can use the Online Fee Lookup function on the TMHP website.

The Online Fee Lookup allows you to:

  • Retrieve real-time fee information.
  • Search for procedure code reimbursement rates individually, in a list, or in a range.
  • Search and review contracted rates.
  • Retrieve up to 24 months of history for a procedure code by searching for specific dates of service within that time period.
  • Search for benefits and limitations for dental and durable medical equipment (DME) procedure codes.

If you have a question that’s not listed here, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413 or the CSHCN Services Program at the Department of State Health Services at 1-800-252-8023.


CSHCN Services Program Inquiry Line: 1-800-252-8023

CSHCN Services Program
Department of State Health Services, MC 1938
P.O. Box 149347
Austin, TX 78714-9347

email CSHCN Services Program 

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Last updated February 06, 2012