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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.2 Eligibility Verification : 4.2.2 Contract with Outside Parties

The State Medicaid Manual, Chapter 2, “State Organization,” (Section 2080.18) allows states to contract with outside agents to confirm for providers the eligibility of a Medicaid client. Medicaid providers may contract with these agents for eligibility verification with a cost to the provider. The provider remains responsible for adhering to the claims filing instructions in this manual. The provider, not the agent, is responsible for meeting the 95-day filing deadline and other claims submission criteria.

Texas Medicaid & Healthcare Partnership
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