<<Back | Historical Rule for the Texas Administrative Code |
TITLE 1 | ADMINISTRATION |
PART 15 | TEXAS HEALTH AND HUMAN SERVICES COMMISSION |
CHAPTER 371 | MEDICAID FRAUD AND ABUSE PROGRAM INTEGRITY |
SUBCHAPTER C | UTILIZATION REVIEW |
RULE §371.208 | Appeals Related To Utilization Review Department Review Decisions |
If a hospital receives notification from the Texas Health and Human Services Commission (HHSC) Utilization Review Department 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 the HHSC Resolution Services, Medical/Administrative Appeals Unit. The written notification of adverse decision will set out the time frame within which the appeal must be received by the HHSC Resolution Services, Medical/Administrative Appeals Unit. |
Source Note: The provisions of this §371.208 adopted to be effective March 30, 2003, 28 TexReg 2481 |