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Electronic Submission Option for MAP Crossover Claims to Be Available December 9, 2024

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Beginning December 9, 2024, Texas Medicaid acute care providers will have the option to submit Medicare Advantage Plan (MAP) crossover claims and attachments electronically. To make an electronic submission, providers must submit the following items at the same time:

  • An electronic data interchange (EDI) claims transaction EDI X12 837
  • An EDI X12 275, the corresponding attachment containing the Medicare explanation of benefits (EOB)

Complete details will be available in the updated 837I and 837P Acute Care Companion Guides and the new 275 Acute Care Guide. The companion guides will be published in early October 2024. A provider notification will be published to inform providers when they are available.

Electronic Claims

Current EDI claim submitters intending to submit MAP claims electronically must:

Only 275 attachment transactions will be accepted for MAP claims. Attachments for all other claim types will be rejected.

Providers that want to submit electronic claims to TMHP can refer to the “Get Started” section on TMHP’s EDI web page.

For questions about EDI testing or submission, call the TMHP EDI Help Desk at 888-863-3638.

Paper Claims

Providers currently submitting MAP crossover claims on paper to TMHP may continue to submit without change.

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