Statutes, codes, and regulations
Texas Administrative Code
Title 1 - ADMINISTRATIONPart 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSIONChapter 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

1 Tex. Admin. Code § 371.208

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Current through Reg. 49, No. 52; December 27, 2024
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.

1 Tex. Admin. Code § 371.208

The provisions of this §371.208 adopted to be effective March 30, 2003, 28 TexReg 2481; Amended to be effective August 1, 2006, 31 TexReg 5603; Amended by Texas Register, Volume 41, Number 17, April 22, 2016, TexReg 2943, eff. 5/1/2016