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Important Notice

On May 1, 2016, HHSC implemented a new physical, occupational, and speech therapy medical policy for children and adults per the cost-containment medical policy initiatives outlined in Rider 50.  However, some cost-containment items were postponed.

HHSC is now pursuing the initiatives outlined in the attached. The changes will ensure compliance with federal billing guidelines. The changes will also ensure reimbursement rates accurately reflect the level of the professional delivering a service and refine the billing and coding design to accurately reflect the amount of time spent with a client.

September 1, 2017 is the effective date for all initiatives.  Please see information below for a comprehensive list of changes and frequently asked questions.

For ProvidersProvider Home Page

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Here is your go-to guide for RightCare

Provider Manual

Filled with useful information, your provider handbook helps you care for your patients the way they need. It’s pretty handy to have, especially if you don’t always have Internet access. Inside you’ll find:

If you need this book in a different format such as audio, large print, braille, or in a language other than English and Spanish, call RightCare Member Services.


Provider Information

RightCare Provider Relations and Services Hotline (including claims questions) 1-855-TX-RIGHT (1-855-897-4448)

  • Provider Newsletters — All the latest information regarding Medicaid and information Provider's should know. 
  • Provider Advisory Group— RightCare will conduct quarterly Provider Advisory Groups with network providers to address any needs and concerns from the provider population. The Provider Advisory Group will include acute care, pharmacy providers, SWHP Provider Services, Medicaid Operations staff, and the RightCare Medicaid Medical Director. SWHP will review phone calls and complaint logs to determine patterns of concern that need to be addressed. SWHP will solicit providers for participation after they have completed the contracting and credentialing process. Provider feedback will be requested on the Provider Manual, newsletters, and the RightCare website. RightCare will utilize technology to engage providers across the service area. For more information on Provider Advisory Groups, please contact RightCare Provider Relations at 1-855-TX-RIGHT (1-855-897-4448).

HHSC Notifications

2017-2018 Texas Medicaid Standing Order for Mosquito Repellent


Notice to Prescribers: Mosquito Repellent Benefit


Notice to Pharmacies: Mosquito Repellent Benefit


Provider Complaints

RightCare recommends that all complaints received from providers be submitted in writing to:

RightCare from Scott & White Health Plan
Attn: Dispute Resolution
MS-A4-144
1206 West Campus Drive
Temple, TX 76502
1-855-TX-RIGHT (1-855-897-4448)

Or by e-mail to: swhpappealsandgrievances@bswhealth.org

A provider who believes that they did not receive full due process from RightCare may file a complaint with HHSC. Providers must exhaust the complaint/appeal process with RightCare before filing a complaint with HHSC. Complaints must be in writing and received by HHSC within sixty (60) calendar days from RightCare’s notification of final action. A provider may file a complaint with the HHSC at the following address:

Texas Health and Human Services Commission
Re: Provider Complaint
Health Plan Operations, H-320
PO Box 85200
Austin, TX 78708

Or by e-mail to: HPM_Complaints@hhsc.state.tx.us

Provider Claim Appeals

A claim appeal is a request for reconsideration of payment for a previously adjudicated claim. Providers who are filing an appeal of a claim decision will need to submit a copy of the Explanation of Benefits (EOB) page showing the claim in question, a claim form, and other supporting documentation including the reason for the appeal. Providers should submit one copy of the EOB for each claim to be appealed and circle which claim is being appealed. The reason for the appeal or reconsideration request may be written on the EOB or described in a separate document. All information should be printed on a single side of the copy. If the original claim was denied for incorrect information, a new CMS 1500 or UB-04 with the corrected information should be submitted as a corrected claim and follow the process indicated below. Appeals must be written, and submitted within 120 days from the date of disposition, which is the date on the Remittance Advice. All appeal requests will receive an acknowledgement letter within 10 days of receipt of the appeal. RightCare will adjudicate all appeals within 30 days of receipt of the appeal. Submit all correspondence to:

RightCare from Scott & White Health Plan
Attn: Claims Appeals
MS-A4-144
1206 West Campus Drive
Temple, Texas 76502
1-855-TX-RIGHT (1-855-897-4448)

Or by e-mail to: swhpappealsandgrievances@bswhealth.org