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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 7: Appeals : 7.1 Appeal Methods : 7.1.6 Appeals Submitted Incorrectly

If an incomplete appeal is received, it is returned to the sender with further appeal instructions and a request for more information. Documentation (either by letter or facsimile) that does not clearly indicate the reason for submission is returned to the sender for clarification.
If an appeal is received that may be more appropriately addressed in another department, the appeal is forwarded to the appropriate department for research and response.
If the TMHP Medical Director or designee identifies a pattern of ineffective use of the appeals process, the provider may be referred to a provider relations representative for assistance.

Texas Medicaid & Healthcare Partnership
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