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7.2 Authorization or Prior Authorization Appeals
Authorization or prior authorization requests that do not contain all of the information necessary for the program to make a determination are denied.
Denied authorization or prior authorization requests may be corrected and resubmitted. To be considered, corrected requests must meet authorization or prior authorization submission deadlines. This constitutes the initial appeal process.
Providers dissatisfied with TMHP's decision to deny authorization or prior authorization of services may submit a request for an administrative review to the Texas Department of State Health Services (DSHS)-Children with Special Health Care Needs (CSHCN) Services Program.
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