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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 7: Appeals : 7.1 Appeal Methods : 7.1.2 Resubmission of TMHP Electronic Data Interchange (EDI) Rejections

TMHP EDI transactions that fail HIPAA edits are rejected, and the submitter receives a TMHP EDI Rejected Transaction Report. The Rejected Transaction Report lists activity by submitter, provider, and payer. Each rejection report includes member identifier, patient last name and first initial, patient control number (PCN), document control number (DCN), type of bill or place of service, charge, transaction from and to dates, receipt date, rejection code, and rejection description.
Providers who receive TMHP EDI Rejected Transaction Reports may resubmit an electronic claim within 95 days of the date of service. A paper appeal may also be submitted with a copy of the transaction rejection report within 120 days of the transaction rejection report to meet the filing deadline. A copy of the Rejected Transaction Report must accompany each corrected claim that is submitted on paper.

Texas Medicaid & Healthcare Partnership
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