TMPPM 2008 > Provider Information > Appeals > Refunds

6.2 Refunds

The TMHP Cash Reimbursement Unit is responsible for processing financial adjustments when overpayment, duplicate payment, payment to incorrect providers, and overpayments because of overlapping payments by Medicaid and another source occur. An overpayment must be refunded to Medicaid, but the amount refunded to TMHP does not exceed the Medicaid payment except in specific situations regarding other insurance payments as stated in "Refunds to TMHP Resulting from Other Insurance Payments and Conditions Surrounding Provider Billing of Third Party Insurers" .

Providers have the option of refunding by issuing a check to TMHP or requesting a recoupment through the paper appeal process. The paper appeal process does not require a provider to issue a check because the refund amount is reduced from the R&S report. To accurately process claim refunds, the TMHP Cash Reimbursement Unit requests that the refund check be accompanied by a Refund Information Form, found on page B-104, with the following information:

•Refunding provider's name and provider identifier.

•Client's name and Medicaid ID number.

•The date the medical service was rendered.

•A copy of the R&S report showing the claim to which the refund is being applied.

•The specific reason for the refund.

If private insurance paid on the claim, the provider gives the exact amount paid and the insurance company's name, address, policy number, and group number.

To request the forms, contact the TMHP Contact Center at 1-800-925-9126, or write to the following address:

Texas Medicaid & Healthcare Partnership
Contact Center
12357-B Riata Trace Parkway, Suite 150
Austin, TX 78727