MedicaidAdministrativeLow impact
Reminder About Claims Submissions for $10 Million or More
Texas Medicaid·TX·General
Effective date
Jun 1, 2026
We identified it
May 16, 2026
Summary
Texas Medicaid providers must split inpatient claims of $10 million or more into separate interim claims using specific type of bill codes (TOB 112, 113, 114) and contact TMHP for manual processing when claims are initially denied. This procedure will be formally added to the provider manual on June 1, 2026.
Action Required
Before June 1, 2026: Billing team must establish procedures for splitting any inpatient claims exceeding $10 million into separate interim claims using TOB 112 (first interim), TOB 113 (subsequent), and TOB 114 (final discharge). Train staff to contact TMHP at 800-925-9126 for manual review when these claims are initially denied. Update billing system workflows to flag claims approaching $10 million threshold.