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Claims Reprocessing for Procedure Codes J0696 and J1100 Submitted by Family Planning Providers

Last updated on 8/28/2020

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.

TMHP has identified an issue that affects claims submitted with dates of service from November 1, 2019 through July 28, 2020, with injection procedure codes J0696 and J1100 for Family Planning providers.

These claims may have been processed incorrectly. Affected claims submitted with dates of service from November 1, 2019 through July 28, 2020, and procedure codes J0696 and J1100, may be reprocessed. Affected claims may result in an additional payment or recoupment, which will be reflected on future Remittance and Status Reports. No action on the part of the provider is required.

For more information, call the TMHP Contact Center at 800-925-9126.