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What is the time limit for submitting a Medicaid claim in Texas?

All claims for services rendered to Texas Medicaid clients who do not have Medicare benefits are subject to a filing deadline from the date of service of: 95 days for in-state providers. 365 days for out-of-state providers. TMHP cannot issue a prior authorization before Medicaid enrollment is complete.

What is a Level 1 appeal?

The first level of an appeal for Original Medicare is called a redetermination. A redetermination is performed by the same contractor that processed your Medicare claim. However, the individual that performs the appeal is not the same individual that processed your claim.

What is the payer ID to TMHP?

Q) The TMHP Companion Guide indicates the payer name is TDHS/TDMHMR.

How do I check my TMHP claim status?

Call 800-925-9126, Option 1 to check claim status, client eligibility, benefit limitations, current weekly payment amount, and claim appeals. Eligibility and claim status information is available 23 hours a day, 7 days a week, with scheduled down time between 3 a.m. and 4 a.m., Central Time.

How do I appeal a Medicaid denial in Texas?

How do I file an appeal? If you have received a Notice of Agency Action, instructions for requesting an appeal are included on the notice. If you have not received a notice, you may contact 2-1-1 or visit your local office. An appeal may be requested in person, by telephone, fax or mail.

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How do I know if I qualify for Medicaid in Texas?

Call toll-free at 800-252-8263, 2-1-1 or 877-541-7905. Choose English or Spanish. Choose option 2. The person you speak with can help you find out if you have Medicaid or not.

How do I attest NPI with TMHP?

To attest the NPI, login to the provider account at the NPPES website and review the taxonomies selected (attested) for the NPI.

How do I appeal a TMHP claim?

If a claim cannot be appealed electronically or by using AIS, providers may appeal the claim on paper by completing the following: 1) Submit a copy of the R&S page on which the claim is paid or denied or other official notification from TMHP (i.e., TMHP letters attached to returned claims).

What is TMHP?

The Texas Medicaid & Healthcare Partnership provides the resources to help providers succeed with their Medicaid practice.

How do I check my TMHP claim?

If you are a Long Term Care provider, contact TMHP's EDI Help Desk at 888-863-3638 to request the correct form. The following information MUST be completed before you can be granted Claim Status Inquiry (CSI) access.

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