Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter J - MEDICAID THIRD PARTY RECOVERY
Division 6 - BILLING AND PAYMENT GUIDELINES
Section 354.2356 - Provider Requirements to Bill Third Party Health Coverage
Current through Reg. 49, No. 38; September 20, 2024
(a) To the extent allowed by federal law, a health care service provider must seek reimbursement from any third party resource that the provider knows about or should know about before billing Medicaid, except for Medicaid programs and services that are required to be paid first prior to billing the third party resource.
(b) Providers cannot bill Medicaid recipients for copayments, deductibles, or coinsurance for Medicaid-covered services. If a recipient's third party resource does not cover a copayment, deductible, or coinsurance, the provider must bill Medicaid for reimbursement of the copayment, deductible, or coinsurance, as follows.
