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5.11.1.3 Verbal Denial
Providers may call the other insurance resource and receive a verbal denial. The other insurance record can either be updated when the provider files the claim or calls the TPR Customer Service at 1-800-846-7307. When calling TPR Customer Service line and when filing claims to TMHP, the provider must have the information below before any updates are made.
Verbal denial requirements:
• Date of the telephone call to the other insurance resource.
•Insurance company's name and telephone number.
•Name of the individual contacted at the insurance company.
•Policyholder and group information for the client.
•Specific reason for the denial, including the client's type of coverage to enhance the accuracy of future claims processing (for example, a policy that covers inpatient services or physician services only).
Providers that update a client's insurance records through the TMHP TPR Customer Service line must follow the current appeal process once the other insurance information has been updated on the client's file.
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