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5.1.4.3 Claims with Incomplete Information and Zero Paid Claims
Claims listed on the Remittance and Status (R&S) report with $0 allowed and $0 paid may be resubmitted as electronic appeals. Previously, these claims were only accepted as paper claims and were not accepted as electronic appeals. Appeals may be submitted through a third-party biller or through TexMedConnect.
Zero-paid claims that are still within the 95-day filing deadline should be submitted as new day claims, which process faster than appeals. Claims can be resubmitted past the 95-day deadline as new day claims if the following fields have not changed:
• Provider identifiers.
•Client Medicaid number.
•Dates of service.
•Total billed amount.
All other appeal guidelines remain unchanged.
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