TMPPM 2010 > Volume 1, General Information > Section 4: Client Eligibility > Medicare and Medicaid Dual Eligibility > Medicare Part C

4.9.4 Medicare Part C

HHSC contracts with some Medicare Advantage Plans (MAPs) and offers a per-client-per-month payment. The payment to the MAP includes all costs associated with the Medicaid cost sharing for dual-eligible clients. MAPs that contract with HHSC will reimburse providers directly for the cost sharing obligations that are attributable to dual-eligible clients enrolled in the MAP. These payments are included in the capitated rate paid to the HMO and must not be billed to TMHP or a Medicaid client.

TMHP now processes certain claims for clients enrolled in a Medicare Advantage Plan (Part C).

Refer to: Subsection 6.13.1, "Medicare Advantage Plans (MAPs) Claims" in Section 6, "Claims Filing" (Vol.1, General Information).

A list of MAPs that have contracted with HHSC is available in the "EDI" section of the TMHP website at www.tmhp.com. The list will be updated as additional plans initiate contracts.