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Update to “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.

An update is available to the article titled “Claims Reprocessing of Some Claims For Clients With Eligibility Issue During PHE” that was published on tmhp.com on September 29, 2022.

The update states that providers that have not submitted claims for affected clients can submit those claims to Texas Medicaid & Healthcare Partnership (TMHP) by March 1, 2023. Claims that are denied due to being filed after the deadline will be reprocessed by May 05, 2023. Providers do not have to appeal these claims.

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