TMPPM 2008 > Provider Information > Client Eligibility > Restricted Medicaid Coverage

   
 

4.3.4.1 Medical Services Not Related to the Terminal Illness

Providers must submit a claim for Medicaid services to TMHP with a statement and documentation from the hospice that the services billed are not related to the client's terminal illness. If TMHP denies the claim, providers must send an appeal with the following information:

A copy of the Remittance and Status (R&S) report, with the client/claim number in question circled.

Clinical records, which may be obtained from the hospice provider.

Supporting documentation giving reasons the services billed are not related to the terminal illness.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
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