TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Medicare Claims > Medicare Advantage Plans (MAPs) Claims


6.13.1 Medicare Advantage Plans (MAPs) Claims

TMHP processes certain claims for clients enrolled in a MAP for Medicare Qualified Medicaid Beneficiary (MQMB) clients.

TMHP considers a claim for reimbursement for services that are a benefit of Texas Medicaid if claims are denied by the MAP for not a benefit or services exceed benefit limitations

Claims must first be submitted to the MAP. If the MAP issues a denial that indicates "not a benefit" or "exceeds benefit limitations," the claim can be submitted to TMHP with a copy of the MAP explanation of benefits (EOB) attached.

Note: TMHP will not process claims that were denied by the MAP for reasons other than "not a benefit" or "exceeds benefit limitations."

Texas Medicaid & Healthcare Partnership
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