12/27/2024
What’s New
December 9, 2024, Texas Medicaid rolled out an electronic submission option for Medicare Advantage Plan Crossover claims and corresponding attachment for acute care providers. This enhancement aims to streamline the process and improve efficiency for providers.
Key Details
Providers must:
Submit the following items to Texas Medicaid & Healthcare Partnership at the same time to:
- An electronic data interchange claims transaction, EDI X12 837
- An EDI X12 275, attachments will be accepted for MAP claims only. All other attachments will be rejected.
- Refer to the “Get Started” section on TMHP’s EDI webpage.
Note: Above does not change the paper claim process; providers continue submitting MAP crossover claims on paper to TMHP.
Complete details are available in the updated 837I and 837P Acute Care Companion Guides and the new 275 Acute Care Guide.
If you have questions or require assistance, please reach out to our Medicaid Provider Network Team at 1-855-212-1615 or email Texas Medicaid Network Department.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.