Rider 32 Implementation Reminder
Date: 07/15/25
Beginning September 1, 2025, the Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually eligible clients (clients who are eligible for both Medicare and Medicaid) enrolled in Medicaid managed care from a Fee-For-Service (FFS) to a managed care service delivery system. Superior HealthPlan will be responsible for the adjudication of these claims.
Provider Responsibilities:
Providers must submit claims for Medicaid-only services for dual eligible clients enrolled in Medicaid managed care directly to the Managed Care Organization (MCO).
If a provider submits a claim to Texas Medicaid & Healthcare Partnership (TMHP) in error:
- TMHP will forward the claim to the appropriate MCO; and
- TMHP’s response will reflect that the claim was forwarded, but TMHP will not issue an Electronic Remittance and Status (ER&S) Report.
TMHP will forward these claims based on dates of service on or after September 1, 2025. TMHP will no longer adjudicate these claims.
Providers should contact the member’s MCO directly for claim status updates and questions related to adjudication.
For a list of Medicaid-only services impacted by this change, see the Rider 32 Procedure Code List (PDF). For questions, please contact your dedicated Provider Representative. To access their information, visit the Find My Provider Representative webpage.
Please note: This article is related to the previously posted article: UPDATED NOTICE: Rider 32 Implementation Information