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2012 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2. Overview of Medicaid Managed Care : 2.6 Reimbursement : 2.6.1 Coinsurance and Deductible Payments for Dual-Eligible Clients

2.6.1
Crossover claims for coinsurance and deductible payments are processed by TMHP and not the client's MCO.
For clients who are enrolled in a Medicare Advantage Plan (MAP) and/or Special Needs Plan (SNP), crossover claims for coinsurance and deductible payments are processed by the MAP and/or SNP. These claims are not processed by TMHP.

Texas Medicaid & Healthcare Partnership
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