Effective October 20, 2020, renal dialysis providers will no longer be reimbursed for some revenue codes. Also, claims submitted on or after September 1, 2016, will no longer be payable to renal dialysis providers with these revenue codes. These providers are reimbursed at a composite reimbursement rate per Texas Administrative Code TAC 355.8660. These claims may have been reimbursed at 100 percent of the interim reimbursement rate in error, instead of the composite reimbursement rate. Affected providers may have received overpayments.
TMHP will reprocess affected claims that were submitted on or after September 1, 2016, and apply the correct payment reductions. When claims are reprocessed, any overpayments that were made may be deducted from future payments (i.e., recouped). Deductions will be reflected on Remittance and Status (R&S) Reports.
Click here to see revenue codes that are not appropriate for renal dialysis providers.
Providers can refer to the current Texas Medicaid Provider Procedures Manual, Volume 1, General Information, section 7, “Appeals,” for more information about prior authorization denial administrative reviews.
For more information, call the TMHP Contact Center at 800-925-9126.