CSHCN 2009 > Client Benefits and Eligibility > Clients Eligible for Medicaid and CSHCN Services Program Benefits

3.6 Clients Eligible for Medicaid and CSHCN Services Program Benefits

If the Medicaid claims administrator (TMHP) denies a claim with explanation of benefits (EOB) code 00182 (client not eligible), but the family has evidence that the client is eligible for Medicaid, providers must appeal or resubmit the claim to TMHP. Client Medicaid eligibility information may not have been available at the time of the first claim submission.

The Medicaid Texas Health Steps-Comprehensive Care Program (THSteps-CCP) and Texas Medicaid (Title XIX) Home Health Services cover medically necessary services for enrolled clients who are 20 years of age or younger. The CSHCN Services Program does not consider reimbursement for services provided to children who are also eligible for Medicaid, with the exception of the transportation of a deceased client's body.

The CSHCN Services Program does not pay claims for clients eligible for Medicaid THSteps-CCP that are denied by Medicaid for any reason, including late filing, limited client, duplicate services, incorrect claim form, or additional information required.

For additional information about Medicaid THSteps-CCP, call 1-800-846-7470, which is available Monday through Friday, from 7 a.m. to 7 p.m, Central Time.

Information regarding Medicaid is printed on the CSHCN Services Program Eligibility Form. The coverage is indicated by the word Medicaid, below the date of birth in the CSHCN Services Program Client Number block. This information is obtained at the time of the application, and it must be verified at the time service is provided.

If Medicaid pays benefits that also were paid by the CSHCN Services Program, the full CSHCN Services Program payment must be refunded. Providers must make the refund check payable to TMHP and send it to the attention of the TMHP Financial Unit. The refund check must be accompanied by a "CSHCN Services Program Refund Information Form," found on page B-130 with the following address:

Texas Medicaid & Healthcare Partnership
Attn: Financial Unit
12357-B Riata Trace Parkway, Suite 150
Austin, TX 78727

The following information must be included:

•Client name and CSHCN Services Program client number

•Copies of the Remittance and Status (R&S) Reports from both Texas Medicaid and the CSHCN Services Program showing the claims were paid

•Date of service

•Provider name

•Provider identifier numbers