TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Filing Medicare Primary Paper Claims > Filing a Medicare-Denied Claim


6.14.5 Filing a Medicare-Denied Claim

Claims denied by Medicare because the services are not a benefit of the Medicare program or because Medicare benefits have been exhausted can be submitted to TMHP for MQMB clients.

The Medicare EOB that contains the relevant claim denial must be submitted to TMHP with the completed claim from within 95 days from the Medicare disposition date and 365 days from the date of service. These claims will be processed as Medicaid-only claims.

Exception: Claims that are denied by Medicare for administrative reasons must be appealed to Medicare before they are submitted to Texas Medicaid.

Texas Medicaid & Healthcare Partnership
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