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6.4 Cost Report Settlement Appeal Process
A provider who is dissatisfied with the determination contained in the Notice of Amount of Program Reimbursement (NPR) from TMHP Medicaid Audit may request an appeal as follows:
• The request for appeal must be in writing.
•The request for appeal must be filed within 120 calendar days from the date of receipt of the NPR.
•If the amount in controversy is at least $1,000, the request for the appeal must be filed with TMHP Medicaid Audit.
•If the NPR shows that the provider is indebted to the Texas Medicaid Program, TMHP must take the necessary action to recover the overpayment, including a suspension of interim payments. This process will take place even if an appeal has been requested.
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