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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.12 Contract with Outside Parties

4.12 Contract with Outside Parties
The State Medicaid Manual, Chapter 2, “State Organization,” (Section 2080.18) allows states to contract with outside agents to confirm for providers the eligibility of a Medicaid client. Medicaid providers may contract with these agents for eligibility verification with a cost to the provider. The provider remains responsible for adhering to the claims filing instructions in this manual. The provider, not the agent, is responsible for meeting the 95‑day filing deadline and other claims submission criteria.

Texas Medicaid & Healthcare Partnership
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