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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 7: Appeals : 7.1 Appeal Methods : 7.1.3 Automated Inquiry System (AIS) Appeals

7.1.3
The following appeals may be submitted using AIS:
Client eligibility. The client’s correct Medicaid number, name, and date of birth are required.
Provider information (excluding Medicare crossovers). The correct provider identifier is required for the billing provider, performing provider, referring provider, and limited provider. The name and address of the provider are required for the facility and outside laboratory.
Claim corrections. Providers may correct the following:
The following appeals may not be appealed through AIS:
Claims listed as pending or in process with EOPS messages
Claims denied as past filing deadline except when retroactive eligibility deadlines apply
Claims denied as past the payment deadline
Providers may appeal these denials either electronically or on paper.
Refer to:
Subsection 7.1.1.2, “Disallowed Electronic Appeals” in this section to determine whether these appeals can be billed electronically. If these appeals cannot be billed electronically, a paper claim must be submitted.
Exception:
Inpatient hospital claims denied for lack of a Hysterectomy Acknowledgment Statement or a Sterilization Consent Form may be appealed if the requested form has been faxed according to the instructions under subsection 5.10, “Hysterectomy Services” in the Gynecological and Reproductive Health and Family Planning Services Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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