TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Remittance and Status (R&S) Report > R&S Report Section Explanation > Claims - Paid or Denied


6.11.4 R&S Report Section Explanation Claims - Paid or Denied

The heading Claims - Paid or Denied Claims is centered on the top of each page in this section. Claims in this section finalized the week before the preparation of the R&S Report. The claims are sorted by claim status, claim type, and by order of client names. The reported status of each claim will not change unless further action is initiated by the provider, HHSC, or TMHP.

The following information is provided on a separate line for all inpatient hospital claims processed according to prospective payment methodology:

Age. Client's age according to TMHP records

Sex. Client's sex according to TMHP records:
M = Male, F = Female, U = Unknown

Pat-Stat. Indicates the client's status at the time of discharge or the last DOS on the claim (refer to instructions for UB-04 CMS-1450 claim form, Block 17)

Proc. ICD-9-CM code indicates the primary surgical procedure used in determining the DRG

Important: Only paper claims appear in this section of the R&S Report. Claims filed electronically without required information are rejected. Users are required to retrieve the response file to determine reasons for rejections.

TMHP cannot process incomplete claims. Incomplete claims may be submitted as original claims only if the resubmission is received by TMHP within the original filing deadline.

Refer to: Subsection 6.1, "Claims Information" in this section for a description of different claim types.

Texas Medicaid & Healthcare Partnership
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