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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.6 Reimbursement : 2.6.1 Coinsurance and Deductible Payments for Dual-Eligible Clients

2.6.1
Crossover claims for payment for deductibles or coinsurance according to current payment guidelines are processed by TMHP and not the client’s MCO.
For clients who are enrolled in a Medicare Advantage Plan (MAP) and/or Special Needs Plan (SNP), crossover claims for coinsurance and deductible payments are processed by the MAP and/or SNP. These claims are not processed by TMHP.

Texas Medicaid & Healthcare Partnership
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