B-1230, Releasable Information for Medicaid Providers and Their Contractors

Revision 19-3; Effective July 1, 2019

All Programs

Applicant Data
  • Name
  • SSN*
  • Social Security Claim Number (SSCN or PCN)*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Category Code
  • Application Number
  • Application Disposition Date
  • Application Status
  • Client Number
Client Data
  • Name
  • Client Number
  • SSN*
  • SSCN*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Certification Date
  • Claims Administrator Update Date (Ins Sub Date)
  • Last Medical Update Date
  • Code for Type Change in Medical Coverage
  • Medicaid:
    • Open Date
    • Close Date
    • Type Coverage
    • Category
    • Type Program
    • Qualified Medicare Beneficiary (QMB) Indicator, if applicable
    • Medically Needy Indicator, if applicable
    • Client Medical Record
    • Case Numbers (active)
  • Third-Party Resource (TPR) Policy Occurs (most recent three):
    • Ins. Policy Number
    • Ins. Policy Sequence
    • Ins. Information Status
    • Type Coverage
    • Company Number
    • Group Number
    • Ins. Begin Date
    • Ins. End Date
    • Ins. Policy Holder
    • Ins. Employer
  • Medicare (Yes or No)
  • Texas Health Steps Data:
    • Texas Health Steps Decision Date
    • Dental Treatment Date
    • Medical Screen Date
  • Lock-in Data (most recent six):
    • Provider Type
    • Provider Name
    • Start Date
    • Through Date
Public Assistance (PA) Case Data
  • Case Number
  • Eligibility Determination Group (EDG) Number
  • Case Name
  • Case Status
  • Three Month Prior Date
  • End Date (For Medically Needy)
  • Denial Reasons **
  • Type Program
  • Active Clients List:
    • Client Number
    • Name
    • Date of Birth
    • Sex
  • Three Months Prior with Spend Down (not the spend down amount)

 

* Staff must confirm that the number given by the requestor is correct. Staff do not release Social Security numbers.

** Only the following denial reasons can be released:

Reason
Refusal to furnish information
Failure to furnish information
Appointment not kept (application/review)
Unable to locate
Voluntary withdrawal