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New OIG UR Submission Process for Some Hospital Providers

Last updated on 6/26/2020

Information posted June 26, 2020

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

The Texas Health and Human Services Commission Office of Inspector General Utilization Review (HHSC OIG UR) is piloting new digital submission processes for some hospital providers to minimize submissions of paper medical records and improve efficiency. Hospital providers selected for the pilot will be notified at the time of record requests, and will be provided contact and support information for the options available.

Note: This pilot is not replacing the SharePoint submission of medical record requests, which is available to all hospital providers; the process for current SharePoint users will remain the same. Hospital providers interested in submitting electronic records through SharePoint should contact OIG_UR@hhsc.state.tx.us.

Providers interested in learning more about this pilot program can review the OIG Digital Scanning Job Aid on the TMHP Learning Management System (LMS). Users must have a user name and password to access the LMS. New users should register to obtain a user name and password. To register, click here, and then click “Don't have an account? Sign up here.”