1 Tex. Admin. Code § 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.

Notes

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