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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 7: Appeals : 7.1 Appeal Methods : 7.1.1 Electronic Appeal Submission : 7.1.1.2 Disallowed Electronic Appeals

7.1.1.2
Disallowed Electronic Appeals
The following claims may not be appealed electronically:
Claims listed as pending or in process with explanation of pending status (EOPS) messages.
Claims denied as past filing deadline except when retroactive eligibility deadlines apply.
Claims denied as past the payment deadline.
Exception:
Inpatient hospital claims denied for lack of a Hysterectomy Acknowledgment Statement or a Sterilization Consent Form may be appealed electronically if the requested form has been faxed according to the instructions in Form GN.5, “Hysterectomy Acknowledgement Form” in the Gynecological and Reproductive Health and Family Planning Services Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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