Under the fiscal agent arrangement, TMHP is responsible for paying claims, and the state is responsible for covering the cost of claims. A fiscal agent arrangement is one of two methods allowed under federal law and is used by all other states that contract with outside entities for Medicaid claims payment. TMHP acts as the state’s Medicaid fiscal agent. Providers can submit an appeal with medical documentation if the claim has been denied. Services that have been authorized for an extension of the benefit limitation will not be recouped. Claims that have been submitted and paid may be recouped if a new claim with an earlier date of service is submitted, depending on the benefit limitations for the services rendered.
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