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20.5.4.2 Electronic Appeal Submission
Electronic appeal submission is a method of submitting Texas Medicaid appeals using a personal computer (PC). The electronic appeals feature can be accessed by a business organization bridging directly into the TMHP EDI Gateway or by using TexMedConnect or TDHconnect.
Advantages of Electronic Appeal Submission
Using electronic appeal submission provides the following advantages to the users:
• Increased accuracy of appeals filed to potentially improve cash flow.
•Print and download capabilities help maintain audit trails.
•Appeal submission windows can be automatically filled in with electronic R&S report information, thereby reducing data entry time.
•Increases speed of payment processing.
Paper Appeals
Appeal the claim on paper by completing the following steps:
•Make a copy of the R&S page where the claim is reported or other official notification from TMHP.
•Circle one claim per R&S page for each adjustment.
•Identify the incorrect and/or missing information and submit changes that should be used to appeal the claim.
•Attach a copy of supporting medical documentation that is necessary or requested by TMHP.
•Attach a copy of the original claim, if available, or the corrected claim form for the appeal. Claim copies are helpful when the appeal involves medical policy or procedure coding issues.
Submit correspondence, adjustments, and appeals to the following address:
Texas Medicaid & Healthcare Partnership
Inquiry Control Unit
12357-B Riata Trace Parkway, Suite 150
Austin, TX 78727
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