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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.16 Claims for Medicaid Hospice Clients Not Related to the Terminal Illness

6.16
When the services are unrelated to the terminal illness, providers must submit a claim for Medicaid services to TMHP. The claim must include a statement and documentation from the hospice that the services billed are not related to the client’s terminal illness.
If TMHP denies the claim, the following information must be submitted with the providers appeal.
Refer to:
Subsection 4.4.3, “Hospice Program” in “Section 4: Client Eligibility” (Vol. 1, General Information) for more information related to Medicaid hospice client benefits and eligibility.

Texas Medicaid & Healthcare Partnership
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