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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.1 Claims Information : 6.1.5 HHSC Payment Deadline

Payment deadline rules, as defined by HHSC, affect all providers with the exception of LTC and the HHSC Family Planning Program. The HHSC payment deadline rules for the fiscal agent arrangement ensure that state and federal financial requirements are met.
TMHP is required to finalize and pay claims within 24 months of:
Texas Medicaid and Children with Special Health Care Needs (CSHCN) Service Program payments, excluding crossovers, cannot be made after 24 months. Claims and appeals that are submitted after the designated payment deadlines are denied.
Providers may appeal HHSC Office of Inspector General (OIG) initiated claims adjustments (recoupments) after the 24‑month deadline but must do so within 120 days from the date of the recoupment. Refer to subsection 7.1.4, “Paper Appeals” in “Section 7: Appeals” (Vol. 1, General Information) for instructions. All appeals of OIG recoupments must be submitted by paper, no electronic or telephone appeals will be accepted.

Texas Medicaid & Healthcare Partnership
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