TMPPM 2008 > Texas Medicaid Services > Dental > Claims Information

19.24.1 Claim Appeals

A claim denied because of age restrictions or other limitations listed in the Medicaid dental fee schedule may be considered for reimbursement on appeal when client medical necessity is provided to the TMHP Dental Director.

All denied claim appeals (see "Appeals" ) must be submitted to TMHP with the exception of a request to waive late filing deadlines. TMHP does not have the authority to waive state or federal mandates regarding claim filing deadlines.

If after all appeal processes at TMHP are exhausted, and the provider remains dissatisfied with TMHP's decision concerning the appeal, the provider may file a complaint with the HHSC Claims Administrator Contract Management Unit.

Refer to: "Administrative Claim Appeals" .

Note: Providers must exhaust the appeals process with TMHP before filing a complaint to the HHSC Claims Administrator Contract Management Unit.

Refer to: "Paper Appeals" .