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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.12 Other Insurance Claims Filing : 6.12.2 Other Insurance Credits : 6.12.2.3 Verbal Denial

6.12.2.3
Verbal Denial
Providers may call the other insurance resource and receive a verbal denial. The other insurance record can either be updated when the provider files the claim or calls the TPL/Tort Customer Service line at 1‑800‑846‑7307. When calling the TPL/Tort Customer Service line and when filing claims to TMHP, the provider must have the following information before any updates are made.
Verbal denial requirements:
Specific reason for the denial, including the client’s type of coverage to enhance the accuracy of future claims processing (for example, a policy that covers inpatient services or physician services only)
Providers that update a client’s insurance records through the TMHP TPL/Tort Customer Service line must follow the current appeal process once the other insurance information has been updated on the client’s file.

Texas Medicaid & Healthcare Partnership
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