Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - HEMOPHILIA ASSISTANCE PROGRAM
Section 354.11 - Claims Payment
Universal Citation: 26 TX Admin Code ยง 354.11
Current through Reg. 49, No. 38; September 20, 2024
(a) Prior authorization is required for all allowable products.
(b) The program reimburses program providers for allowable product(s) for eligible clients. Payment may be made only after the allowable product(s) has been dispensed and submission of a valid claim. Claims must be:
(1) submitted on the claim
form accepted by the program;
(2)
submitted by a program provider; and
(3) filed directly with the
program.
(c) The program reimburses eligible clients for insurance premium payments made to program approved health plans. Reimbursements may be made after the program's receipt of a valid proof of insurance premium payment.
(d) Filing Deadlines.
(1) Complete claims must be received by the
program within 95 calendar days from the end of the month of the date of
service or 95 calendar days from the end of the month for which the premium was
paid.
(2) Incomplete and ineligible
claims will be denied.
(3) Denied
claims may be considered for payment if the claim is corrected and resubmitted
within 30 days following the date of the program notice of denial or within the
initial 95 day filing deadline, whichever is later.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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