TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Remittance and Status (R&S) Report > R&S Report Section Explanation > Financial Transactions

   
 

6.11.4.3.3 Refunds

Refunds are identified by EOB 00124, "Thank you for your refund; your 1099 liability has been credited." This statement is verification that dollars refunded to TMHP for incorrect payments have been received and posted. The provider's check number and the date of the check are printed on the R&S Report. Claim refunds appear on the R&S Report in the following format:

Claim Specific:

ICN. The claim number of the claim to which the refund was applied this cycle.

Patient Name. The first name, middle initial, and last name of the patient on the applicable claim.

Medicaid Number. The patient's Medicaid or CSHCN number.

Date of Service. The format MMDDCCYY (month, day, and year) in "From" DOS.

Total Billed. The total amount billed for the claim being refunded.

Amount Applied This Cycle. The refund amount applied to the claim.

EOB. Corresponds to the reason code assigned.

Nonclaim Specific:

Control Number. A control number to reference when corresponding with TMHP.

FYE. The fiscal year for which this refund is applicable.

EOB. Corresponds to the reason code assigned.


Texas Medicaid & Healthcare Partnership
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