This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:36 GMT
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.