TX HHS Form 2358. Habilitation Coordination Authorization Request

The TX HHS Form 2358, Habilitation Coordination Authorization Request, is a crucial document for individuals seeking habilitation services. This form helps solve the problem of coordinating habilitation services with Medicaid eligibility by providing authorization for specific services.

This form is typically used in situations where an individual requires habilitation services to support their daily living needs. The form requires key information such as the individual's name, social security number, and Medicaid number, as well as the start and end dates of the authorization period. Additionally, the form specifies the type of request being made (e.g., initial, renewal, or revision) and includes a section for the habilitation coordinator to certify that the form meets all requirements set forth in the Habilitation Coordination Billing Guidelines Handbook.

Processing time for this form typically takes five to seven business days, after which service authorizations will appear on the Medicaid Eligibility Service Authorization Verification (MESAV). It is essential to submit this form by fax to Provider Claims Services at 512-438-2301. Key points to note include:

• Type of request being made: initial, renewal, revision, or termination
• Required information: individual's name, social security number, and Medicaid number
• Certification by the habilitation coordinator that the form meets all requirements set forth in the Habilitation Coordination Billing Guidelines Handbook
• Processing time: five to seven business days for service authorizations to appear on MESAV