What’s an EOB?
TMHP is required to provide the subscriber with an
Explanation of Benefits (EOB) in response to the filing of a
claim. These EOBs provide information about claim
disposition and/or payment. TMHP provides many different
messages to assist the subscriber with further filing
instructions on a processed claim.
The following are examples of reasons that prompt an EOB
- Service rendered by a nonparticipating
- Services denied based on the participating
provider’s failure to follow the protocol for
- The service denied due to failure to obtain
prior authorization where it is the provider’s
obligation to obtain such approval.
- Coverage for the insured or subscriber was
no longer in effect on the date of the service.
- Under the Managed Care arena, participating
provider bills for covered services for which
the provider has not contracted with the
The following list represents the top five EOB messages,
which are listed according to provider type and specialty.
Click here to view the Top 5 reasons for denial.
There are many other examples of messages that are placed on
the Remittance and Status report to providers. For more
information regarding these messages, please feel free to
contact the TMHP Contact Center at 1-800-925-9126.
In addition, TMHP provides free-of-charge workshops and other
educational resources for providers and interested parties
across the State of Texas.
Visit the Provider Education section to register for these
free workshops and to learn more about Texas Medicaid billing,