TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Claims Information > HHSC Payment Deadline

   
 

6.1.4 HHSC Payment Deadline

Payment deadline rules, as defined by HHSC, affect all providers with the exception of LTC and Family Planning Titles V, X, and XX.

The new HHSC payment deadline rules for the fiscal agent arrangement ensure that state and federal financial requirements are met. TMHP is required to finalize and pay claims within a determined time frame (see table below), based on provider, claim, or eligibility type.

The following table describes the new payment deadline rules:

Type
Description

All Providers

Medicaid/CSHCN payments, excluding crossovers, cannot be made after 24 months from each DOS on the claim (discharge date for inpatient claims.)

Refugee Clients

The payable period for all refugee Medicaid payments is the federal fiscal year (October-September) in which each DOS (discharge date for inpatient claims) occurs plus 1 additional federal fiscal year.

Medicaid Crossover Claims

The crossover file create date is the date in which the file is received by Medicaid. The state has 24 months from the create date to pay the crossover claim.

For paper submissions, the state has 24 months from the Medicare disposition date to pay a crossover claim.

Retroactive SSI Eligibility (clients)

The payment deadline is derived from the client's eligibility "add date"; to allow 24 months from the add date for the retroactive Supplemental Security Income (SSI)-eligible client.

County Indigent SSI Eligibility (clients)

The payment deadline is derived from the client's eligibility add date; to allow 24 months from the add date to pay the claim.

Claims and appeals submitted after the designated payment deadlines are denied.

Note: Providers may appeal HHSC Office of Inspector General (OIG) initiated claims adjustments (recoupments) after the 24-month deadline but must do so within 120 days from the date of the recoupment. Refer to subsection 7.1.4, "Paper Appeals" in Section 7, "Appeals" (Vol. 1, General Information) for instructions. All appeals of OIG recoupments must be submitted by paper, no electronic or telephone appeals will be accepted.


Texas Medicaid & Healthcare Partnership
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