Texas HMO Reconciliation of Benefits to Schedule of Charges is a process used by health plans to reconcile the payments they make to providers with the charges the providers submit for services. This process is used to ensure that payments are accurate and that providers are not overcharging for services. The Texas HMO Reconciliation of Benefits to Schedule of Charges includes: 1. Review of the provider's Schedule of Charges: The HMO will compare the provider's Schedule of Charges to the plan's Maximum Allowable Charge (MAC) list. The MAC list is the maximum dollar amount that the plan will pay for a service. If the Schedule of Charges exceeds the MAC list, the HMO will adjust the payment to the MAC list amount. 2. Comparison of Payment to Charges: The HMO will compare the amount paid to the provider's charges. If the amount paid is less than the provider's charges, the HMO will adjust the payment to the provider's charges. 3. Audit of Payments: The HMO will audit payments to ensure that they are accurate and compliant with the plan's policies and procedures. 4. Denial of Services: The HMO may deny services if the provider's charges exceed the plan's Maximum Allowable Charges. These are the four components of Texas HMO Reconciliation of Benefits to Schedule of Charges. This process is an important part of ensuring that payments to providers are accurate and compliant with the plan's policies and procedures.