General Category > General Questions

Facility Medicaid Billing

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mariorodriguez36:
Has anyone had tons of issues with billing a Texas Medicaid HMO? We submit everything correct then bill denies. Appeals are submitted using plan portal and information isn't received. Has anyone had to submit a complaint to the state? Where did you do so? We are tired and don't know what else to do

Michele:
Sorry but we haven't had these issues.  We do bill Texas Medicaid HMOs.

mariorodriguez36:
How do you handle two ER visits within 24 hours? We have a payer that will pay one claim and the other they global our charges. The TMHP manual states "If a client visits the
Emergency Room more than once in one day, the times must be given for each visit.". We've informed the payer that we do this and they still global our claims.

We were wondering if any other facilities have this issue?

Michele:
Have you filed an appeal?

mariorodriguez36:
Yes, we appeal with all the documentation TMHP states we need but still globals.

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