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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.10 MCO/Dental Plan Appeals, Complaints, and Fair Hearings

Providers can submit their appeals directly to the MCO or dental plan that administers the clients’ managed care benefits.
Claims that were originally submitted to TMHP for routing to the appropriate MCO or dental plan can be appealed to TMHP using TexMedConnect or EDI. The appeals will be routed to the appropriate entity for processing.
Refer to:
Subsection 6.4, “Complaints and Appeals” in this handbook for additional information about NorthSTAR complaints and appeals.

Texas Medicaid & Healthcare Partnership
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