Claim Appeals for Medicaid
How and when to appeal a claim, and when to escalate an appeal.
All Activities
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Texas Health Steps
Texas Health Steps CBT contains information on topics that will demonstrate how the Texas health Steps program is building brighter futures by caring for Texas children.
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Long-Term Care (LTC) Hospice Form 3071 Election/Cancellation/ Discharge Notice and 3074 Physician Certification of Terminal Illness Webinar
This webinar discusses how to fill out, submit, and correct Forms 3071 and 3074.
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Accessible PDF: EVV Acronyms
The EVV Acronyms infographic provides definitions to frequently used acronyms related to Electronic Visit Verification (EVV).
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Medical Transportation Program
This CBT discusses the basics of the MTP, including services offered, how potential MTP providers apply to the program, the claims process, and resources.
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CSHCN Services Program Training
The CSHCN Services Program Training presents information that provides new and current CSHCN Services Program providers with an overview of the program.
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EVV Portal Training for HCS-TxHmL, YES-HCBS-AMH, and CLASS-DBMD Program Providers
Initial Electronic Visit Verification (EVV) Portal Training for Program Providers affected by the 21st Century Cures Act. Previously live streamed October 28, 2020 and November 18, 2020
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Paper Claim Forms
This CBT discusses procedures and general guidelines for submitting paper claims. This CBT does not discuss electronic claim submission. Refer to the TexMedConnect for Acute Care Providers CBT for information regarding electronic claim submission.
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Crossover Claims
The Crossover Claims CBT provides an overview of the process for submitting claims and receiving reimbursement when a client has both Medicare and Medicaid.
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Ambulance Basics CBT
The Ambulance Basics CBT contains information for regarding policies and procedures for providing ambulance transports for Medicaid and CSHCN Services Program clients.
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Claim Appeals for CSHCN
The goal of this training is to discuss the various levels of claim appeals and methods for submitting them. In this training, we'll look at three different scenarios involving claim appeals.
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TexMedConnect for Acute Care Providers
This CBT provides information for Acute Care Providers CBT about using TexMedConnect to verify client eligibility, enter and submit claims and appeals, and find claim status.
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Third Party Liability
The Third Party Liability (TPL) computer-based training (CBT) educates providers on TPL, identifying other insurance and third party resources (TPRs), and responsibilities for filing claims and reporting other insurance and TPR to TMHP.
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Client Eligibility
The Client Eligibility CBT will help providers identify client eligibility, retroactive eligibility, and benefits related to various programs. This training also includes methods used to verify eligibility and where to find this information.
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Remittance and Status Report
The Remittance and Status Report CBT contains information for providers regarding how to access R&S Reports, including a description of the different sections of the R&S Report.for Medicaid and CSHCN Services Program Clients.
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Durable Medical Equipment (DME)
This CBT will introduce providers to the basics of enrolling and providing services and goods as a Medicaid DME provider.
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Youth Empowerment Services (YES) Waiver Webinar
The YES Waiver Webinar contains information for YES Waiver providers regarding the relationship between YES Waiver and TMHP.
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Prior Authorization Webinar
The Prior Authorization (PA) Webinar is intended to educate Texas Medicaid and Children with Special Health care Needs (CSHCN) Services Program providers on prior authorization guidelines, processes, requirements, and tools available for submitting prior authorizations.
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Introduction to Medicaid Basics Webinar
The Introduction to Medicaid Basics webinar contains basic information for providers regarding policies and procedures related to Medicaid, CSHCN Services Program, and other State Health-care clients.
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Writing Functional Therapy Goals
Texas Medicaid requires functional goals for all PT, OT, and ST plans of care. To help providers integrate this requirement into therapy plans of care, the Writing Functional Therapy Goals webinar will explore this process in depth.
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Telemedicine and Telehealth Services Webinar
This webinar introduced providers to information and reference materials for Telemedicine and Telehealth Services.
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The Prescribed Pediatric Extended Care Center (PPECC) Webinar
The Prescribed Pediatric Extended Care Center (PPECC) Webinar provides an overview of the new benefit as well as assists Medicaid and CSHCN Services Program providers with enrollment and prior authorization submissions.
