For fee-for-service and Primary Care Case Management claims, Texas Medicaid requires prior authorization for outpatient diagnostic radiology services, including computed tomography, magnetic resonance, positron emission tomography, and cardiac nuclear imaging.
Submit your request to MedSolutions, using this form (PDF). Access to the MedSolutions online prior authorization portal is available from TMHP's Radiology Prior Authorization Services page. Or, you may submit requests to MedSolutions by phone at (800) 572-2116, or fax at (800) 572-2119.
For urgent or emergent situations requiring advanced diagnostic imaging, you may request retroactive authorization online through MedSolutions no later than 14 calendar days after the day on which the study was completed (even if you end up having to submit the request by another method).
You can find details about the Medicaid prior authorization process in the Prior Authorization section and the Radiology and Laboratory Services Handbook of the Texas Medicaid Provider Procedures Manual.
For more information, call the TMHP Contact Center at (800) 925-9126.