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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.13 Third Party Liability (TPL) : 4.13.6 Third Party Liability - Tort : 4.13.6.4 Informational Claim Converting to Claims for Payment

4.13.6.4
If providers have submitted an informational claim to TMHP but have not received payment from the liable third party, they must make one of the following determinations and notify TMHP within 18 months of the date of service:
Providers can continue to pursue a claim for payment against the third party and forego the right to convert an informational claim to a claim for payment by Texas Medicaid.
Providers that decide to convert an informational claim to a claim for payment consideration must submit a request to TMHP. The request must be submitted:
TMHP/Tort Department
P0 Box 202948
Austin, TX 78720-2948
Fax: (512) 514-4225
TMHP will not accept any conversion request that is submitted more than 18 months after the date of service, regardless of whether an informational claim was submitted timely to TMHP. All payment deadlines are enforced regardless of whether the provider decides to pursue a third party claim. The conversion of informational claims to actual claims is not a guarantee of payment by TMHP.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.