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December 2016 Texas Medicaid Provider Procedures Manual

Section 5: Fee‑for‑Service Prior Authorizations : 5.8 Prior Authorization Denials Appeals Process

5.8
Prior authorizations that are denied by TMHP can be resubmitted to the TMHP Prior Authorization Department with new or additional information for reconsideration.
If the request is denied a second time, or if the provider has no new or additional information, the provider may file an Administrative Appeal to HHSC. Providers must include a copy of the denial letter.
It is strongly recommended that providers maintain a list that details the prior authorizations, including:
This information will be required if a provider needs to file an administrative review.

Texas Medicaid & Healthcare Partnership
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