26 Tex. Admin. Code § 365.7 - Claims Submission and Payment Rates

(a) Drug benefit claims must be submitted electronically by the pharmacy to the designated claims processor for the program, except when paper submissions are allowed or required.

(b) Medical benefit claims must be submitted to the program by the provider who rendered the service(s) to the program client or by the provider's designee.

(c) Transportation benefit claims must be submitted to the program by the client or an authorized entity. Claims must be submitted electronically through the current automated claims payment system, except when the program allows or requires paper submissions.

(d) Payments are made using the rates in effect on the date the service is rendered.

(e) Claims for medical benefits will not be considered for payment by the program until the program has a fully executed agreement with the provider.

(f) Incomplete or incorrect claims will not be considered for payment.

Notes

26 Tex. Admin. Code § 365.7

The provisions of this §365.7 adopted to be effective February 18, 2010, 35 TexReg 1220; amended to be effective March 27, 2016, 41 TexReg 2170; transferred effective January 15, 2022, as published in the December 31, 2021 issue of the Texas Register, 46 TexReg 9421