TMPPM 2008 > Provider Information > Appeals > Appeals to HHSC Fee-for-Service and PCCM

6.3.3 PCCM DRG Adjustment Appeals

PCCM contracted hospitals may appeal to the HHSC Medical & UR Appeals Unit only if they have followed the prior authorization process with TMHP. The Medical and UR Appeals Unit must receive the written appeal request within 120 days of the date of the last R&S report. If the request is not received within 120 days, the appeal is not conducted, and the TMHP decision is considered final. The request must include a copy of the complete medical record, an original, signed, properly completed, and notarized Affidavit (see "Affidavit"), and a letter explaining the reason for the appeal. Extensions of time are not granted for filing the written appeal request, submitting the complete medical record, or submitting the original, properly completed, and notarized affidavit in the format approved by HHSC.

Important: Only claims denied for medical necessity may be submitted to and considered by the HHSC Medical & UR Appeals Unit. Claims that receive a technical denial are not accepted.

Refer to: "Appeals of Denied Requests for Authorization" for additional information about the PCCM inpatient authorization process.