For Providers

Remote patient monitoring with Criterion Health Care is a good choice for you if:

  • You are a Texas Medicaid care provider
  • You treat patients with conditions that require routine monitoring
  • You are ready to get started as a telemonitoring provider in Texas

Who is Eligible?

Telemedicine and telemonitoring services may be provided not only by physicians but by:

  • Nurse Practitioners (NP)
  • Clinical Nurse Specialists (CNS)
  • Certified Nurse Midwives (CNM)
  • Licensed Professional Counselors (LPC)
  • Licensed Marriage and Family Therapists (LMFT)
  • Licensed Clinical Social Workers (LCSW)
  • Physician Assistants (PA)
  • Psychologists
  • Licensed Psychological Associates
  • Provisionally Licensed Psychologists
  • Licensed Dieticians

What You Should Know: Pre-Authorization

Per the Texas Medicaid Provider Procedures Manual, telemedicine and telehealth services do not require pre-authorization in most cases. However, to qualify for telemonitoring, the service offered through Criterion, patients must exhibit specific risk factors to be eligible for coverage. These must include two or more of the following risk factors:

  • Two or more hospitalizations in the previous 12-month period
  • Frequent or recurrent emergency department visits
  • A documented history of poor adherence to ordered medication regimens
  • Documented history of falls in the previous 6-month period
  • Limited or absent informal support systems
  • Living alone or being home alone for extended periods of time
  • A documented history of care access challenges

Pre-authorization is granted for 60 days at a time and must be requested by the home health agency overseeing care with a completed Home Telemonitoring Services Prior Authorization Request form. This form must be signed and dated by a physician.

Why Work With Criterion?

Criterion Healthcare partners with providers to coordinate and manage remote patient monitoring services to qualified recipients in the state of Texas. We provide guidance and assistance in meeting Medicaid requirements for billing, authorization, technology, and all other elements of telemonitoring.

Criterion is a good choice for providers who are interested in providing telemonitoring but are not ready to move into full-scale video-based telemedicine.