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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 3. School Health and Related Services (SHARS) : 3.5 Claims Filing and Reimbursement : 3.5.1 Claims Information : Appealing Denied SHARS Claims
Appealing Denied SHARS Claims
SHARS providers that appeal claims denied for exceeding benefit limitations must submit documentation of medical necessity with the appeal. Documentation submitted with an appeal must include the pages from the IEP and ARD documents that show the authorization of the services, including the specified frequency and duration and the details of the need for additional time or the reasons for exceeding the benefit limitations.
Each page of the documentation must have the client’s name and Medicaid number.

Texas Medicaid & Healthcare Partnership
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