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Procedure Code A4335 Rejections for Dual-Eligible Medicaid Clients

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For dates of service (DOSs) on or after September 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) does not adjudicate claims submitted by providers for Medicaid-only services that they provide to dual-eligible clients who are enrolled in a managed care organization (MCO). TMHP forwards the claims to the MCO for processing. Claim responses will show that the claims were forwarded, and TMHP will not generate an Electronic Remittance and Status (ER&S) Report.

Claims for A4335 Rejected

TMHP incorrectly rejected this type of claim if it was submitted from September 1, 2025, to September 4, 2025, with procedure code A4335 and a DOS after September 1, 2025. Providers that submitted a claim that was rejected during this time period should resubmit their claims to TMHP for forwarding.

Single Claims for Multiple Payers

Providers who submit claims using TexMedConnect or electronic data interchange (EDI) must limit them to a single payer. If a claim is submitted with details that are payable by both the MCO and TMHP, TMHP will reject the claim. Providers must submit a separate claim for each payer.

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

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.