Two Texas Medicaid Plans Left August 31. The Claims Window Shrank to 95 Days.

TMHP first gave providers 24 months to bill Baylor Scott & White and FirstCare, then revised it on September 2. If the 95 days run from each date of service, the oldest summer sessions are already out.

Baylor Scott & White Health Plan and FirstCare stopped serving Texas Medicaid and CHIP members on August 31, 2026. On September 2, TMHP revised its instructions: “Providers have 95 days to submit their claims with a DOS on or before August 31, 2026.” Its July 17 notice had said “Providers will have 24 months,” with a federal deadline of August 31, 2028. That 24-month window no longer applies.

The turn: it's a rolling deadline, and part of it has passed

The update doesn't say what the 95 days count from. Baylor Scott & White's own claims page states its standing rule: “All claims must be received in our office within 95 days of the date of service or they will be denied.” If that's the clock, there's no single deadline. Each session has its own, and for sessions before about June 19 it has already closed. Sessions on August 31 run to about December 4.

ABA bills weekly in units, and claims held for an authorization fix or a corrected modifier are common. A practice that parked those claims on the strength of the July notice may now be late.

Who it reaches

TMHP end-dated four plan codes on August 31:

  • 06 FirstCare CHIP, Lubbock
  • 50 FirstCare STAR, Lubbock
  • W4 FirstCare STAR, MRSA West
  • C3 Baylor Scott & White STAR, MRSA Central

“Any claims with a DOS on or after September 1, 2026, will be rejected.” Members moved to new plans on September 1.

The limits

TMHP hasn't explained why it replaced 24 months with 95 days, or confirmed the starting point. The July notice also said “prior authorization processes will not be affected,” which doesn't settle whether an authorization with the old plan carries over to the new one. Ask the new plan directly.

What you must know or do

  • Billing: run an aging report this week for every claim under plan codes 06, 50, W4 and C3 with a date of service through August 31 that's unbilled, rejected or waiting on a correction. Submit oldest first.
  • For anything older than about June 19, call the TMHP Contact Center at 800-925-9126 before assuming it's lost, and write down the reference number.
  • Intake: confirm each affected client's new plan, that you're in its network, and that you hold an authorization with it for dates from September 1.