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6.3.1.3 Exceptions to the 24-Month Payment Deadline
HHSC shall consider exceptions to the 24-month claims payment deadline for the situations listed below. The final decision about whether a claim falls within one of the exceptions will be made by HHSC.
• Refugee Eligible Status: The payable period for all Refugee Medicaid eligible recipient claims is the federal fiscal year in which each date of service occurs plus one additional Federal Fiscal year. The date of service for inpatient claims is the discharge date.
•Medicare/Medicaid Eligible Status: The payable period for Medicaid/Medicare eligible recipient claims filed electronically is 24 months from the date the file is received from Medicare by TMHP or the claims processing entity. The payable period for Medicaid/Medicare eligible recipient claims filed on paper is 24 months from the date listed on the Medicare Remittance Advice.
•Retroactive Supplemental Security Income (SSI) Eligible: The payable period for SSI Medicaid eligible recipients when the Medicaid eligibility is determined retroactively is 24 months from the date the Medicaid eligibility is added to the eligibility file. The date is referred to as the "add date."
Mail exception requests to HHSC at the following address:
Texas Health and Human Services Commission
HHSC Claims Administrator Contract Management
Mail Code 91X
PO Box 204077
Austin, Texas 78720-4077
Note: Medicaid health maintenance organization (HMO) providers must communicate with their respective HMOs regarding appeals related to the filing deadline or any exception request policy. HHSC Claims Administrator Contract Management does not have the authority to manage these appeals.
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