Texas MedicaidLow ImpactAdministrative
Reminder About Claims Submissions for $10 Million or More
Published May 16, 2026Effective June 1, 2026
AI 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.
Plan Types
Medicaid
States
TX
Specialties
all-specialties