What is Electronic Eligibility Verification?

Electronic eligibility verification is a method of accessing Texas Medicaid and CIDC eligibility information using a personal computer. Eligibility information can be accessed by a business organization bridging directly into TexMedNet or by using the TDHconnect application, the free Windows-based software available from NHIC.

You can submit an eligibility verification inquiry either by patient number, or by entering two of the following three items: name, date of birth or Social Security number. City, county, sex or Zip code are optional search fields available on each request to help further identify the client, if needed.

The response displays detailed information about the following client eligibility aspects, when applicable:

• Medicaid/Chronically Ill and Disabled Children's Services (CIDC)
• Medicare
• Lock-in
• Prior authorization
• Other insurance
• Medicaid managed care
• Benefit limitations, furnishing last service dates on eyeglass, dental, hearing aid and screening services

What are the advantages to Electronic Eligibility Verification?

• Inquiries can be submitted using your personal computer.
• Inquiries regarding eligibility information are possible 24 hours a day, 7 days a week.
• The TexMedNet system receives file updates from the Texas Department of Human Services each business day, thereby ensuring access to up-to-date information.
• Span dates can be entered for a 31-day period for each request.
• Interactive requests (single transactions) receive a response within 15 seconds.
• Batch requests (multiple transactions) receive a response within 24 hours.
• A report for users to print or download is generated for batch responses.
• Users are able to download or print interactive responses.

How is this service accessed?

Eligibility verification is available to business organizations (i.e., billing organizations, vendors and clearinghouses) interfacing directly with TexMedNet or through TDHconnect.

How can business organizations not using TDHconnect access TexMedNet?

Electronic data interchange (EDI) standards approved by the health care industry, are used and mapped to Texas Medicaid requirements to facilitate open access. Upon completion, Texas-specific formats are available for download from the TexMedNet BBS. Industry standards for telecommunications are also used. Electronic batch submission responses are deposited to the submitter's TexMedNet Production BBS mail box. The following formats are used for electronic eligibility:

TexMedNet Home Page