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EDI FAQ
To make an appeal, you must contact Molina within 60 calendar days of the denial. You, your approved representative (this can be a friend, family member, attorney), or a provider can file an appeal by phone or in writing.
Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided.
Form 1322, Texas Medicaid Prior Authorization Reconsideration Request | Texas Health and Human Services.
Appeals must be received by TMHP within 120 days of the disposition date on the R&S Report on which the claim appears. A 95-day or 120-day appeal filing deadline that falls on a weekend or a holiday is extended to the next business day following the weekend or holiday.
Timeliness: 90-Day Deadline Providers must submit an appeal in writing within 90 days of the action/inaction precipitating the complaint. Failure to submit an appeal within this 90-day time period will result in the appeal being denied. (See California Code of Regulations, Title 22, Section 51015.)
The request for an appeal must include a copy of the complete medical record, a letter explaining the reasons why the HHSC OIG UR decision is incorrect, a copy of the HHSC OIG UR decision letter, and an original, properly completed, and notarized affidavit in the format approved by HHSC.
A: A provider is required to file a claim within 95 days of the date of service in the absence of a catastrophic event. A provider and an MCC may agree by contract to extend the period for submitting a claim.
An appeal request can be made in writing, by calling 2-1-1 or by visiting a local HHSC office.
CMS-1500 Related content
Exhibit E - Texas Medicaid Provider Procedures...
Mar 1, 2021 — This manual is a comprehensive guide for Texas Medicaid providers. It...
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