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December 2016 Texas Medicaid Provider Procedures Manual

Section 2: Texas Medicaid Fee‑for‑Service Reimbursement : 2.7 Medicare Crossover Claim Reimbursement : 2.7.3 Part C: Medicare Advantage Plans (MAPs)

2.7.3
2.7.3.1
HHSC makes a per-client-per-month payment to MAPs that contract with HHSC. The payment to the MAP includes all costs associated with the Medicare coinsurance and deductible for a client who is dually eligible for Medicare and Medicaid. TMHP does not reimburse the coinsurance or deductible amounts for these claims. These costs must be billed to the MAP and must not be billed to TMHP or the Medicaid client.
Refer to:

Texas Medicaid & Healthcare Partnership
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