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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.13 Medicare Claims : 6.13.1 Coinsurance and Deductible Payment Exceptions

6.13.1
Some MAPs have contracted with HHSC to receive a monthly payment for each client the MAP enrolls. The payment to the MAP includes all Medicaid costs associated with rendering services to MQMB clients. TMHP does not reimburse the copayment, coinsurance, or deductible amounts for these claims. These payments are included in the capitated rate paid to the MCO and must not be billed to TMHP or the Medicaid client.
Refer to:
The EDI section of the TMHP website at www.tmhp.com for a list of MAPs that are contracted with HHSC. The list will be updated as additional plans receive approved contracts.
For crossover claims that are submitted by nephrology (hemodialysis, renal dialysis) and renal dialysis facility providers, Texas Medicaid reimburses the Medicare coinsurance and deductible less five percent.

Texas Medicaid & Healthcare Partnership
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