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December 2016 Texas Medicaid Provider Procedures Manual

Section 2: Texas Medicaid Fee‑for‑Service Reimbursement : 2.4 Using Payouts to Satisfy Accounts Receivables Across Programs and Alternate Provider Identifiers

2.4
Using Payouts to Satisfy Accounts Receivables Across Programs and Alternate Provider Identifiers
The TMHP accounts receivable process identifies funds that a provider owes to TMHP and subtracts these funds from payments to the provider. TMHP satisfies outstanding accounts receivables using all available funds from the providers’ Medicaid payouts, as well as managed care payouts, until the accounts receivables have been recovered. Outstanding balances are recovered as follows:
For outstanding fee-for-service accounts receivables, TMHP first recovers funds from any available fee-for-service payments. If there is still an accounts receivable balance for that week’s financial cycle, TMHP recovers funds from any available managed care payments.
For outstanding managed care accounts receivables, TMHP first recovers funds from any available managed care payments. If there is still an accounts receivable balance for that week’s financial cycle, TMHP will recover funds from any available fee-for-service payments
1099 Reports
Providers receive one 1099 report for each provider identifier. The 1099 report has combined information for both fee-for-service and managed care programs.
Paper Remittance and Status (R&S) Report
The summary page of the R&S report has combined information from the fee-for-service and managed care programs.
The Financial Transactions Sub-Owner Recoupment page has accounts receivable for both programs. A column on the page identifies the program (Medicaid [fee-for-service] or Managed Care) from which the funds were recouped.
The Financial Transactions Accounts Receivable page has the accounts receivable for both programs. A column identifies the program (Medicaid [fee-for-service] or Managed Care) from which the funds were recouped.
The Original Date in the Accounts Receivable section of the R&S Report reflects the date on which the accounts receivable first appeared on the R&S Report.
ER&S Report
The Pending and Non-Pending ER&S Reports have combined information for both programs.

Texas Medicaid & Healthcare Partnership
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