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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 : 6.12.2.5 Filing Deadlines

6.12.2.5
In accordance with federal regulations, all claims must initially be filed with TMHP within 365 days of the DOS. Claims that involve filing to a TPR have the following deadlines:
Claims with a valid disposition (payment or denial) must be received by TMHP within 95 days of the date of disposition by the TPR and within 365 days of the DOS. Appealed claims that were originally denied with EOB 00260, which indicates that the provider files with a TPR, must be received within 95 days of the date of disposition by the TPR or within 120 days of the date on which TMHP denied the claim.
The provider must appeal the claim to TMHP with complete other insurance information, which includes all EOBs and disposition dates. The disposition date is the date on which the other insurance company processed the payment or denial.
If a provider submits other insurance EOBs without disposition dates, the appeal will be denied. If the other insurance disposition date appears only on the first page of an EOB that has multiple pages and the claim that is being submitted to TMHP is on a subsequent page or pages, the provider must submit the first page that shows the disposition date and all of the pages that show the claim that is being submitted to TMHP.
Refer to:
Subsection 4.13, “Third Party Liability (TPL)” in Section 4, “Client Eligibility” (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
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