|
5.1.1 TMHP Processing Procedures
TMHP processes claims for the traditional (fee-for-service) Medicaid and Medicaid Managed Care programs.
Medicaid claims are subject to the following procedures:
• TMHP verifies all required information is present.
•Claims filed under the same provider identifier and program ready for disposition at the end of each week are paid to the provider with an explanation of each payment or denial. The explanation is called the Remittance and Status (R&S) report, which may be received as a downloadable portable document format (PDF) version or on paper. A Health Insurance Portability and Accountability Act (HIPAA)-compliant 835 transaction file is also available for those providers who wish to import claim dispositions into a financial system.
Weekly claim/financial activity, with or without payments, initiate an R&S report being sent to a provider. The report identifies pending, paid, denied, and adjusted claims. If no claim activity or outstanding account receivables exist during the time period, the provider does not receive an R&S report for the week.
Refer to: "Medicaid Managed Care" for TMHP claims processing information related to Medicaid Managed Care.
|
