Texas Medicaid Provider Procedures Manual: Volume 1, General Information (2024)

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SECTION 6: CLAIMS FILING
. For the TMHP Crossover Outpatient Facility Claim Type 31 form, the detail line items are required.
Claims will be denied if the details are omitted.
. The MRAN/MAP template must be submitted with a completed claim form, must be legible, and
must identify only one client per page. Providers must not submit handwritten MRAN/MAP
templates.
Claims that do not meet these standards will not be processed and will be returned to the provider.
By submitting the MRAN/MAP templates to TMHP, the provider attests that the information included
in the form matches the Medicare RA or RN that was received from Medicare or the MAP. If the infor-
mation on the crossover claim type form does not exactly match the information on the RA or RN, the
claim may be denied.
Refer to: Subsection 6.21, "Forms" in this section, for the MRAN/MAP templates and instructions.
Subsection 2.6, "Medicare Crossover Claim Reimbursem*nt"in Section 2, "Texas Medicaid
Fee-for-Service Reimbursem*nt" (Vol. 1, General Information).
6.13.5.2 Crossover Claims Filing Deadlines
The paper crossover claim with all required, EOBs, templates, and forms must be received by TMHP
within 95 days of the Medicare date of disposition and 365 days from the date of service in order to be
considered for processing.
6.13.5.3 Filing a Medicare-Adjusted Claim
Providers may also submit Medicare-adjusted claims by submitting the adjusted Medicare RA/RNs
(paper or electronic) and the appropriate TMHP MRAN/MAP template. The information on the
Medicare RA/RN must exactly match the information submitted on the TMHP MRAN template.
Refer to: Subsection 3.7.1, "Medicaid Relationship to Medicare" in Inpatient and Outpatient
Hospital Services Handbook (Vol. 2, Provider Handbooks) for additional information on
hospital Medicare claims filing requirements.
6.14 Filing Medicare Primary Paper Claims
Providers are allowed to file Medicare primary paper claims to TMHP for payment of coinsurance or
deductible for claims that fail to cross over from Medicare electronically.
Providers that receive paper MRANs from Medicare or a Medicare intermediary or MRANs using the
CMS-approved software MREP, for professional services, or PC-Print, for institutional services, may
submit these MRAN to TMHP. Providers that submit these MRANs are not required to submit the
TMHP Standardized MRAN Form.
Providers that cannot retrieve the MRAN from MREP or PC-Print, or who don't receive.a paper MRAN
from Medicare or a Medicare intermediary, must submit the TMHP Standardized MRAN Form.
Providers that submit paper crossover claims must submit only one of the approved MRAN formats-
MREP, PC-Print, paper MRAN from Medicare or a Medicare intermediary or TMHP Standardized
MRAN form along with a completed claim form. Paper crossover claims that contain multiple MRAN
forms with conflicting information are returned to the provider or denied.
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CPT ONLY - COPYRIGHT 2011 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
 

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