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December 2016 Texas Medicaid Provider Procedures Manual

Section 8: Third Party Liability (TPL) : 8.7 Tort : 8.7.4 Submission of Informational Claims

8.7.4
Providers must submit informational claims to TMHP:
On an Informational Claims Submission Form. Providers should complete only one form per client, regardless of how many separate informational claims are being submitted with the form.
Refer to:
Providers must complete either the Insurance Information field (liable third party) or the Attorney Information field on the Informational Claims Submission Form.
Providers must send the informational claims and the Informational Claims Submission Form by certified mail to TMHP at:
TMHP TPL/Tort Department
PO Box 202948
Austin, TX 78720-2948
TMHP will send providers a letter to confirm that the informational claim was received. The letter will provide the date on which TMHP must receive a request from the provider to convert the informational claim to a claim for payment. If TMHP receives an informational claim that cannot be processed, TMHP will notify the provider of the reason.
Providers can inquire about the status of an informational claim by calling the TMHP TPL/Tort Department at 1‑800‑846‑7307. If a provider has not received confirmation that TMHP has received the informational claim within 30 days, the provider should contact the TMHP TPL/Tort Department at 1‑800‑846‑7307 to validate the status of the request.

Texas Medicaid & Healthcare Partnership
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