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Claims Reprocessing of Some Claims For Clients With Eligibility Issue During PHE

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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.

The Texas Health and Human Services Commission has identified an error that was made ending some clients’ eligibility on or after March 1, 2020. This error occurred during the public health emergency (PHE). The Texas Medicaid & Healthcare Partnership (TMHP) has been directed to reprocess all claims for dates of service on or after March 1, 2020, for those impacted clients. When the claims are reprocessed, providers may receive additional payment, which will be reflected on the Remittance and Status (R&S) Report.

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