Recoupment of IMD Claims

Information posted October 21, 2009: Reminder: Institute for Mental Disease (IMD) services and any associated professional services are not a benefit of Texas Medicaid if they are provided to clients who are from 21 through 64 years of age and residents of an IMD facility.
Beginning October 26, 2009, TMHP will begin to recoup claims that were paid to providers in error for services provided to Medicaid clients who were from 21 through 64 years of age and residents of an IMD facility.
Affected claims will be reprocessed, and payments will be adjusted accordingly. Adjustments will be reflected on providers’ Remittance and Status (R&S) Reports. No action on the part of providers is required.
For more information, call the TMHP Contact Center at 1-800-925-9126.