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October 2014 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.17 Claims for Texas Medicaid and CSHCN Services Program Eligible Clients : 6.17.2 CSHCN Services Program Claims Reprocessing for Retroactive Texas Medicaid Eligibility

6.17.2
Claims that have already been paid by the CSHCN Services Program for clients who received retroactive Texas Medicaid eligibility for dates of service covered on the paid claims will be reprocessed to pay under the appropriate program. The reprocessed CSHCN Services Program claim number will appear under the “Adjustments – Paid or Denied” section of the CSHCN Services Program R&S Report. An accounts receivable will be created for services covered by Texas Medicaid that will be reflected on the “Financial Transactions” page under the “Accounts Receivable” section of the CSHCN Services Program R&S Report. The claim will be reprocessed to Texas Medicaid and given a new claim number. The new Texas Medicaid claim number and disposition will appear under the “Claims – Paid or Denied” section of the Medicaid/Managed Care R&S Report.
TMHP will contact providers when it reprocesses claims for services that require a Texas Medicaid prior authorization. Providers will be informed that a Texas Medicaid prior authorization must be submitted within a specified time frame for the claim to be considered for processing through Texas Medicaid.

Texas Medicaid & Healthcare Partnership
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