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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 7: Appeals : 7.1 Appeal Methods : 7.1.5 Paper Appeals : 7.1.5.1 Texas Medicaid Fee-for-Service DRG Adjustment Appeal

7.1.5.1
Texas Medicaid Fee-for-Service DRG Adjustment Appeal
Texas Medicaid fee-for-service hospital providers who are appealing a DRG adjustment (higher weight DRG) must provide the original and revised UB-04 CMS-1450 paper claim form, the complete medical record, and a statement defining the reason for the requested change. Hospitals have 120 days from the date of the R&S Report to request an addition of a diagnosis or procedure resulting in a DRG adjustment. Providers appealing a DRG that has not been revised by the OIG Utilization Review Unit should appeal to TMHP.
Refer to:

Texas Medicaid & Healthcare Partnership
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