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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 10 PCCM and Managed Care Claims Processed by TMHP Before March 1, 2012 : 10.2 PCCM Cost and Reporting

Providers who rendered services to Texas Medicaid PCCM clients on or before February 29, 2012, must continue to prepare one copy of the applicable CMS Cost Report Form along with the required PCCM supplemental worksheets. The PCCM supplemental worksheets include the Inpatient PCCM D-4 worksheet, available from CMS, and the Outpatient PCCM D, Part V worksheet. A sample of the Outpatient PCCM D, Part V is available on the TMHP website at
Hospitals must include inpatient and outpatient costs in the cost reports submitted annually.
Refer to:
Subsection 2.2.2, “Cost Reimbursement” in Section 2, “Texas Medicaid Fee-for-Service Reimbursement” (Vol. 1, General Information).
Subsection 3.7.4, “Provider Cost and Reporting” in the Inpatient and Outpatient Hospital Services Handbook (Vol. 2, Provider Handbooks) for additional information about cost reporting.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.