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5.2.1 Electronic Claim Acceptance
Providers should verify that their electronic professional claims were accepted by the Texas Medicaid Program for payment consideration by referring to their Claim Response report, which is in the 27S batch response file (e.g., file name E085LDS1.27S). Providers should also check their Accepted and Rejected reports in the rej and acc batch response files (e.g., E085LDS1.REJ and E085LDS1.ACC) for additional information. Only claims that have been accepted on the Claim Response report (27S file) will be considered for payment and made available for claim status inquiry. Claims that are rejected must be corrected and resubmitted for payment consideration. For more information on electronic claims submissions refer to "Electronic Billing" , visit www.tmhp.com, or call the EDI Help Desk at 1-888-863-3638.
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