Medicaid Difficulty Alert - Texas Dentists for Medicaid Reform

Medicaid symbol

The purpose of this Medicaid Difficulty Alert form is to allow Medicaid providers to let TDMR know about current problems they are experiencing with the Texas Medicaid system:

the Health and Human Services Commission,

its Inspector General,

Texas Medicaid and Healthcare Partnership,

Dental Managed Care and its organizations,

the Texas State Board of Dental Examiners,

Department of Health and Human Services or any federal agency associated with Medicaid.

The following form is to be filled out in full. All information is needed so that TDMR can evaluate the problem and follow up on any additional details.
Please provide as many specifics as possible – dates, names, etc.
Do not include any personal health information about a specific patient in violation of HIPAA requirements.
If you wish to upload a document, the form allows you to do that.
You will be contacted to follow up on your concerns.

Name*
First Last
Practice Name*
Email*
Phone*
Location*
City
Agency*
Please choose the agency or agencies you are having problems with.
- TMHP
- HHSC
- Inspector General
- MCNA
- Dentaquest
Area of Concern (please provide as much detail as possible)*
*
- I give TDMR permission to use the above information anonymously to compile data about areas of concern in Texas Medicaid. I understand the specifics will not be disclosed to others without my written permission.
File
Name
This field is for validation purposes and should be left unchanged.