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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.11 Remittance and Status (R&S) Report : 6.11.4 R&S Report Section Explanation

The heading Claims – Paid or Denied Claims is centered on the top of each page in this section. Claims in this section finalized the week before the preparation of the R&S Report. The claims are sorted by claim status, claim type, and by order of client names. The reported status of each claim will not change unless further action is initiated by the provider, HHSC, or TMHP.
The following information is provided on a separate line for all inpatient hospital claims processed according to prospective payment methodology:
Age. Client’s age according to TMHP records
Sex. Client’s sex according to TMHP records: M = Male, F = Female, U = Unknown
Pat-Stat. Indicates the client’s status at the time of discharge or the last DOS on the claim (refer to instructions for UB-04 CMS-1450 paper claim form, Block 17)
Proc. ICD‑10-PCS code indicates the primary surgical procedure used in determining the DRG
Only paper claims appear in this section of the R&S Report. Claims filed electronically without required information are rejected. Users are required to retrieve the response file to determine reasons for rejections.
TMHP cannot process incomplete claims. Incomplete claims may be submitted as original claims only if the resubmission is received by TMHP within the original filing deadline.
Refer to:
Subsection 6.1, “Claims Information” in this section for a description of different claim types.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.