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December 2016 Texas Medicaid Provider Procedures Manual

Section 7: Appeals : 7.1 Appeal Methods : 7.1.4 Paper Appeals : Other Insurance Appeals
To appeal a claim denial due to other insurance coverage, the provider must submit complete other insurance information including the disposition date. The disposition date indicates when the other insurance company processed the payment or denial. An appeal submitted without this information will be denied.
If submitting a paper appeal the provider must submit EOBs containing disposition dates. If the disposition date appears only on the first page of an EOB that has multiple pages and the claim that is being appealed is on a subsequent page, the provider must also include the first page of the EOB that shows the disposition date.

Texas Medicaid & Healthcare Partnership
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