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4.10.8.3 Informational Claim Conversion to Claim for Payment
Providers who have filed informational claims with HHSC, but have not received payment from the third party within 18 months from the date of service, must choose before the end of the 18th month from the date of service to do one of the following:
• Continue to pursue a claim against the third party for payment and forego the right to submit a written request for the conversion of the informational claim for payment by Medicaid.
•Submit a letter on hospital or provider letterhead by fax or mail requesting the conversion of the informational claim to a claim for payment by Medicaid. The letter must include the following information: client's name, Medicaid ID, Date of Service, and Total Billed amount as originally stated on the UB-04 CMS-1450 or CMS-1500. HHSC does not accept or pay any claim for payment after 18 months from the date of service has elapsed, regardless of whether an informational claim has been timely filed. All other filing deadlines apply.
Mailing Address:
HHSC/OIG/TPR
INFOC
Mail Code 1354 PO Box 85200
Austin, TX 78708-5200
Fax: 1-512-833-6484
All payment deadlines are enforced regardless of the provider's decision to pursue a third party claim. Once timely notification has been received by HHSC to convert the informational claim to a claim for payment, HHSC forwards the informational claim to TMHP. Informational claims converted to actual claims are not a guarantee of payment by TMHP.
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