Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 371 - MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
Subchapter C - UTILIZATION REVIEW
Section 371.208 - Appeals Related to Utilization Review Department Review Decisions

If a hospital receives notification from HHSC Utilization Review Unit of an adverse decision regarding medical necessity of admission, days of stay, diagnosis related group (DRG) validation, or a final technical denial, the hospital may appeal to HHSC. The written notification of adverse decision sets out the responsible area and time frame within which HHSC must receive the appeal. The Texas Medicaid Policy and Procedure Manual provides additional information on the appeal process.