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HHSC Publishes Preparing for the Upcoming Fiscal year 2021 Fee-for-Service Claims Billing Closeout (IL 2021-27)

Last updated on 6/3/2021

HHSC publishes IL 2021-27 Upcoming Fiscal year 2021 Fee-for-Service Claims Billing Closeout (PDF) in preparation for the August 31, 2021 deadline. It is important for providers to promptly submit claims to be paid by HHSC for any unbilled services.

This information letter will include details on:

12-month file rule – billing for current services and claim problems need to be resolved within the 12-month filing limitation.

Remittance & Status (R&S) reports – Be sure to review your R&S Reports to ensure recoupments on claims paid by HHSC are valid. Invalid recoupments need to be brought to the attention of the state office staff.

Miscellaneous Fee-for-Service claims - Claims for services that are eight years old/or claims totaling less than $50,000 owed to a single legal entity are paid on a first-come, first-served basis using funds appropriated during each legislative session. Claims over $50,000 and/or for services provided more than eight years old cannot be paid except as a special line item in the state budget.

For questions about the R&S Report, contact the Texas Medicaid & Healthcare Partnership at 1-800-626-4117, Option 1.

Questions regarding recoupments, contact HHSC Provider Recoupments & Holds at (512) 438-2200, Option 3.